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Abstract：
BACKGROUND: Children like to discover their environment by putting substances in their mouths. This behavior puts them at risk of accidentally ingesting foreign bodies (FBs) or harmful materials, which can cause serious morbidities.
OBJECTIVE: To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children.
METHODS: We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher\'s exact, Pearson\'s χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison.
RESULTS: A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without.
CONCLUSIONS: Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.
OBJECTIVE: To study the clinical characteristics, diagnosis, complications, management, and outcomes of accidental ingestion of FBs, caustics, and medications in children.
METHODS: We conducted a retrospective cohort study of all children admitted for accidental ingestion to the Department of Pediatrics, Salmaniya Medical Complex, Bahrain, between 2011 and 2021. Demographic data, type of FB/harmful material ingested, and investigations used for diagnosis and management were recorded. The patients were divided into three groups based on the type of ingested material (FBs, caustics, and medications). The three groups were compared based on patient demographics, socioeconomic status (SES), symptoms, ingestion scenario, endoscopic and surgical complications, management, and outcomes. The FB anatomical location was categorized as the esophagus, stomach, and bowel and compared with respect to symptoms. The Fisher\'s exact, Pearson\'s χ2, Mann-Whitney U, and Kruskal-Wallis tests were used for comparison.
RESULTS: A total of 161 accidental ingestion episodes were documented in 153 children. Most children were boys (n = 85, 55.6%), with a median age of 2.8 (interquartile range: 1.8-4.4) years. Most participants ingested FBs (n = 108, 70.6%), 31 (20.3%) ingested caustics, and the remaining 14 (9.2%) ingested medications. Patients with caustic ingestion were younger at the time of presentation (P < 0.001) and were more symptomatic (n = 26/31, 89.7%) than those who ingested medications (n = 8/14, 57.1%) or FBs (n = 52/108, 48.6%) (P < 0.001). The caustic group had more vomiting (P < 0.001) and coughing (P = 0.029) than the other groups. Most FB ingestions were asymptomatic (n = 55/108, 51.4%). In terms of FB location, most esophageal FBs were symptomatic (n = 14/16, 87.5%), whereas most gastric (n = 34/56, 60.7%) and intestinal FBs (n = 19/32, 59.4%) were asymptomatic (P = 0.002). Battery ingestion was the most common (n = 49, 32%). Unsafe toys were the main source of batteries (n = 22/43, 51.2%). Most episodes occurred while playing (n = 49/131, 37.4%) or when they were unwitnessed (n = 78, 57.4%). FBs were ingested more while playing (P < 0.001), caustic ingestion was mainly due to unsafe storage (P < 0.001), and medication ingestion was mostly due to a missing object (P < 0.001). Girls ingested more jewelry items than boys (P = 0.006). The stomach was the common location of FB lodgment, both radiologically (n = 54/123, 43.9%) and endoscopically (n = 31/91, 34%). Of 107/108 (99.1%) patients with FB ingestion, spontaneous passage was noted in 54 (35.5%), endoscopic removal in 46 (30.3%), laparotomy in 5 (3.3%) after magnet ingestion, and direct laryngoscopy in 2 (1.3%). Pharmacological therapy was required for 105 (70.9%) patients; 79/105 (75.2%) in the FB group, 22/29 (75.9%) in the caustic group, and 4/14 (28.8%) in the medication group (P = 0.001). Omeprazole was the commonly used (n = 58; 37.9%) and was used more in the caustic group (n = 19/28, 67.9%) than in the other groups (P = 0.001). Endoscopic and surgical complications were detected in 39/148 (26.4%) patients. The caustic group had more complications than the other groups (P = 0.036). Gastrointestinal perforation developed in the FB group only (n = 5, 3.4%) and was more with magnet ingestion (n = 4) than with other FBs (P < 0.001). In patients with FB ingestion, patients aged < 1 year (P = 0.042), those with middle or low SES (P = 0.028), and those with more symptoms at presentation (P = 0.027) had more complications. Patients with complications had longer hospital stays (P < 0.001) than those without.
CONCLUSIONS: Accidental ingestion in children is a serious condition. Symptomatic infants from middle or low SES families have the highest morbidity. Prevention through parental education and government legislation is crucial.
摘要：
背景：儿童喜欢通过将物质放入口中来发现环境。这种行为使他们面临意外摄入异物(FB)或有害物质的风险，会导致严重的疾病.
目的：研究临床特点，诊断,并发症,管理,以及意外摄入FBs的结果，焦散,和儿童的药物。
方法：我们对所有因意外摄入进入儿科的儿童进行了回顾性队列研究，SalmaniyaMedicalComplex,巴林,2011年至2021年。人口统计数据,摄入的FB/有害物质的类型，并记录用于诊断和管理的调查.根据摄入材料的类型将患者分为三组(FBs，焦散,和药物）。根据患者人口统计学对三组进行比较，社会经济地位(SES)，症状,摄取场景，内窥镜和手术并发症，管理,和结果。FB解剖位置被归类为食管，胃,和肠道，并与症状进行比较。费舍尔的精确，皮尔森的χ2，曼恩-惠特尼U，和Kruskal-Wallis测试用于比较。
结果：共记录153名儿童发生161次意外摄入事件。大多数儿童是男孩（n=85，55.6％），年龄中位数为2.8岁（四分位距：1.8-4.4）。大多数参与者摄入FB(n=108，70.6%)，31（20.3%）摄入焦散，其余14人(9.2%)摄入药物。与摄入药物（n=8/14，57.1％）或FBs（n=52/108，48.6％）相比，出现腐蚀性摄入的患者在出现时更年轻（P<0.001），症状更多（n=26/31，89.7％）（P<0.001）。苛性组呕吐（P<0.001）和咳嗽（P=0.029）多于其他组。大多数FB摄入无症状（n=55/108，51.4%）。就FB位置而言，大多数食管FBs是有症状的（n=14/16，87.5%），而大多数胃（n=34/56，60.7%）和肠FBs（n=19/32，59.4%）无症状（P=0.002）。电池摄入是最常见的（n=49，32％）。不安全的玩具是电池的主要来源（n=22/43，51.2％）。大多数发作发生在玩耍时（n=49/131，37.4%）或未目睹时（n=78，57.4%）。FBs在比赛中摄入更多（P<0.001），苛性摄入主要是由于储存不安全(P<0.001)，药物摄入主要是由于缺少对象（P<0.001）。女孩比男孩摄入更多的珠宝物品（P=0.006）。胃是FB的常见位置，放射学（n=54/123，43.9％）和内窥镜（n=31/91，34％）。在107/108（99.1%）的FB摄入患者中，在54例（35.5％）中记录到自发通道，内窥镜切除46例（30.3%），磁铁摄入后5例（3.3%）剖腹手术，和直接喉镜2（1.3％）。105例（70.9%）患者需要药物治疗；FB组79/105例（75.2%），苛性组22/29（75.9％），药物组4/14(28.8%)(P=0.001)。奥美拉唑是常用的药物（n=58；37.9%），苛性碱组（n=19/28，67.9%）的使用量高于其他组（P=0.001）。在39/148（26.4％）患者中发现了内窥镜和手术并发症。苛性碱组并发症发生率高于其他组(P=0.036)。仅FB组发生胃肠道穿孔（n=5，3.4％），并且磁铁摄入（n=4）比其他FB更多（P<0.001）。在摄入FB的患者中，患者年龄<1岁（P=0.042），SES中或低(P=0.028)，出现症状较多（P=0.027）的患者并发症较多。有并发症的患者比没有并发症的患者住院时间更长（P<0.001）。
结论：儿童意外摄入是一种严重的疾病。来自中或低SES家庭的症状婴儿发病率最高。通过父母教育和政府立法进行预防至关重要。
目的：研究临床特点，诊断,并发症,管理,以及意外摄入FBs的结果，焦散,和儿童的药物。
方法：我们对所有因意外摄入进入儿科的儿童进行了回顾性队列研究，SalmaniyaMedicalComplex,巴林,2011年至2021年。人口统计数据,摄入的FB/有害物质的类型，并记录用于诊断和管理的调查.根据摄入材料的类型将患者分为三组(FBs，焦散,和药物）。根据患者人口统计学对三组进行比较，社会经济地位(SES)，症状,摄取场景，内窥镜和手术并发症，管理,和结果。FB解剖位置被归类为食管，胃,和肠道，并与症状进行比较。费舍尔的精确，皮尔森的χ2，曼恩-惠特尼U，和Kruskal-Wallis测试用于比较。
结果：共记录153名儿童发生161次意外摄入事件。大多数儿童是男孩（n=85，55.6％），年龄中位数为2.8岁（四分位距：1.8-4.4）。大多数参与者摄入FB(n=108，70.6%)，31（20.3%）摄入焦散，其余14人(9.2%)摄入药物。与摄入药物（n=8/14，57.1％）或FBs（n=52/108，48.6％）相比，出现腐蚀性摄入的患者在出现时更年轻（P<0.001），症状更多（n=26/31，89.7％）（P<0.001）。苛性组呕吐（P<0.001）和咳嗽（P=0.029）多于其他组。大多数FB摄入无症状（n=55/108，51.4%）。就FB位置而言，大多数食管FBs是有症状的（n=14/16，87.5%），而大多数胃（n=34/56，60.7%）和肠FBs（n=19/32，59.4%）无症状（P=0.002）。电池摄入是最常见的（n=49，32％）。不安全的玩具是电池的主要来源（n=22/43，51.2％）。大多数发作发生在玩耍时（n=49/131，37.4%）或未目睹时（n=78，57.4%）。FBs在比赛中摄入更多（P<0.001），苛性摄入主要是由于储存不安全(P<0.001)，药物摄入主要是由于缺少对象（P<0.001）。女孩比男孩摄入更多的珠宝物品（P=0.006）。胃是FB的常见位置，放射学（n=54/123，43.9％）和内窥镜（n=31/91，34％）。在107/108（99.1%）的FB摄入患者中，在54例（35.5％）中记录到自发通道，内窥镜切除46例（30.3%），磁铁摄入后5例（3.3%）剖腹手术，和直接喉镜2（1.3％）。105例（70.9%）患者需要药物治疗；FB组79/105例（75.2%），苛性组22/29（75.9％），药物组4/14(28.8%)(P=0.001)。奥美拉唑是常用的药物（n=58；37.9%），苛性碱组（n=19/28，67.9%）的使用量高于其他组（P=0.001）。在39/148（26.4％）患者中发现了内窥镜和手术并发症。苛性碱组并发症发生率高于其他组(P=0.036)。仅FB组发生胃肠道穿孔（n=5，3.4％），并且磁铁摄入（n=4）比其他FB更多（P<0.001）。在摄入FB的患者中，患者年龄<1岁（P=0.042），SES中或低(P=0.028)，出现症状较多（P=0.027）的患者并发症较多。有并发症的患者比没有并发症的患者住院时间更长（P<0.001）。
结论：儿童意外摄入是一种严重的疾病。来自中或低SES家庭的症状婴儿发病率最高。通过父母教育和政府立法进行预防至关重要。
