J. Tashiro1, R. S. Kennedy1, E. A. Perez1, F. Mendoza2, J. E. Sola1 1University Of Miami,Division Of Pediatric Surgery, DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA 2Baptist Children’s Hospital,Children’s Emergency Center,Miami, FL, USA
Introduction: In the pediatric population, ingested foreign bodies are a common cause for emergency department visits. While esophageal foreign bodies may require immediate intervention, gastrointestinal foreign bodies (GIFB) have distinct factors contributing to longer and more costly hospitalizations.
Methods: Patients with ingested foreign bodies were identified using ICD-9-CM 935.2, 936, 937, 938 within the Kids’ Inpatient Database (1997-2009). Ordinal logistic regression models were used to identify predictors of resource utilization. Esophageal ingested foreign bodies (935.1) were excluded from this cohort. Cases were weighted to project national estimates.
Results: Overall, 7,480 cases were identified. Most GIFB patients were ≥5 years of age (56%), male (54%), and Caucasian (57%) with a median (IQR) length of stay (LOS) 2 (3) days, and total charges (TC) 9,295 (14,049). A total of 2,506 procedures were performed, most commonly GI surgery (56%) followed by GI endoscopy (24%), esophagoscopy (11%), and bronchoscopy (9%). A total of 5,110 patients (68% of the cohort) did not have surgery or endoscopy and were not transferred. Psychiatric/cognitive disorders (18%) and self-inflicted/suicidal (5%) were the most common diagnoses. Intestinal perforation (1%) was rare, but intestinal obstruction (5%) was more common.
On multivariate analysis, LOS increased when cases were associated with psychiatric/cognitive disorder (OR=1.9), self-inflicted/suicidal (OR=1.6), intestinal obstruction (OR=1.7), esophageal perforation (OR=40.0), intestinal perforation (OR=4.4), exploratory laparotomy (OR=1.9), and gastric (OR=2.9), small bowel (OR=1.5), or colon surgery (OR=2.5), all p<0.02. Children admitted to hospitals in the Western U.S. had the lowest LOS vs. all other regions, while small bedsize hospitals had higher LOS (OR=1.4), p<0.05.
Higher TC were associated with intestinal obstruction (OR=2.0), endoscopy of esophagus (OR=1.8), stomach (OR=2.1), or colon (OR=3.3), and exploratory laparotomy (OR=3.6) or surgery of stomach (OR=5.6), small bowel (OR=6.4), or colon (OR=3.4), all p<0.001. Hospital mortality was 0.06% (n=5). Western U.S. hospitals had the highest TC vs. all other regions, while small bedsize hospitals had lower TC (OR=0.7), p<0.001.
Conclusion: GIFB affect older children and most do not require surgery or endoscopy. Associated psychiatric disorder or intent to self-harm is seen in over 20% GIFB patients, and surgical or endoscopic procedures are needed in one third of cases. Nevertheless, resource utilization is determined heavily by associated diagnoses and treatment procedures.
