Children Increasingly Visiting EDs After Ingesting Batteries

Larry Hand

May 14, 2012

May 14, 2012 — The number and rate of battery-related emergency department (ED) visits for children younger than 18 years nearly doubled between 1990 and 2009. The risks were highest for children younger than 5 years and often involved the small, coin-like batteries that power toys, games, and watches and for younger children, according to a study published online May 14 and in the June print issue of Pediatrics.

The study authors call for much greater preventive efforts by caregivers and better childproof designs for battery compartments by manufacturers.

Samantha J. Sharpe, BS; Lynne M. Rochette, PhD; and Gary A. Smith, MD, DrPH, all from the Center for Injury Research and Policy, the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, conducted an analysis of data from the National Electronic Injury Surveillance System for the 20-year period.

They estimate that 65,788 children (95% confidence interval, 54,498 - 77,078 children) younger than 18 years visited EDs for battery-related incidents during the study period. That averages to 3289 visits per year, or 1 visit approximately every 3 hours. Almost 80% of the patients were 5 years old or younger. One-year-old children accounted for 20.9% of all visits, which was the largest proportion for any single age.

Overall, the rate of visits increased from 4 per 100,000 children in 1990 to 7.4 per 100,000 in 2009 (m, 0.178; P = .002). For children aged 5 years and younger, however, the rate was almost twice as high and increased from 10 per 100,000 in 1990 to 19.1 per 100,000 in 2009 (m, 0.418; P = .007).

Among the visits for which the type of battery was included in the records, the number of visits associated with coin-like "button" batteries more than doubled from 1301 in 1990 to 2785 in 2009. "[B]utton batteries were implicated in >80% of all ED visits for which battery type was specified," the researchers write. Although this trend was not statistically significant during the 20-year period, it did reach statistical significance during the last 8 years of the study for children aged 5 years and younger. Cylindrical batteries were involved in 16.2% of the visits.

"The 2009 ED visit rate for ingestion of button batteries among children aged <18 years was 3.7 per 100,000 children and 10.1 among ≤5-year-olds," the authors write. In 18 cases, the button battery lodged in the esophagus, where it can damage surrounding tissue by several mechanisms, most importantly by causing electrolysis of tissue fluids and generating hydroxide at the battery's negative pole.

Most visits (76.6%) resulted from children ingesting batteries; nasal cavity insertion accounted for 10.2% of the visits, mouth exposure for 7.5%, and ear canal insertion for 5.7%.

Almost 92% of the children were treated and released from the EDs; the others were admitted, transferred to another hospital, or had other dispositions.

Most Batteries Pass Harmlessly Through the Gastrointestinal Tract

"This study demonstrated a significant increase in the frequency and rate of ED visits due to battery ingestions among children," the researchers write. "Most batteries will pass through the gastrointestinal tract spontaneously without adverse consequences. However, severe morbidity and fatality can occur if the battery lodges in the esophagus."

One of the study's weaknesses, the authors note, is that surveillance data only capture records of ED visits, and not incidents treated at other healthcare facilities. "[T]herefore, this study underestimates the true number of pediatric battery-related exposures."

The National Electronic Injury Surveillance System also does not contain adequate data on mortality or diagnostics, treatment, or outcomes after patients leave EDs, the researchers write. They used US Census data for calculating population-based ED visit rates.

The study also did not yield data on whether increases in visits were a result of increases in exposure or increases in severity of exposure, or whether caregivers were more knowledgeable about battery exposures and sought more care.

The researchers conclude, "Batteries pose an important hazard to children, especially those aged ≤5 years. Primary prevention of battery exposures is critical because of the limited effectiveness of medical interventions once tissue damage has occurred. The increasing number and rate of battery-related ED visits among children underscore the need for increased prevention efforts."

The study was partially supported by the National Center for Injury Prevention and Control at the US Centers for Disease Control and Prevention. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online May 14, 2012. Abstract

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