K. A. Calabro1,2, J. Y. Zhao2, E. A. Bowdish1,2, C. M. Harmon1,2, K. Vali1,2 1John R. Oishei Children’s Hospital,Department Of Pediatric Surgery,Buffalo, NY, USA 2University at Buffalo Jacobs School of Medicine and Biomedical Sciences,Department Of Surgery,Buffalo, NY, USA
Intro:
Accidental wire grill-brush ingestion is a largely unidentified threat to children. Injuries affect multiple organ systems, resulting in morbidity and even mortality. We sought to review available literature to characterize wire grill-brush injury.
Methods:
A review of Ovid MEDLINE ®, PubMed, Google Scholar, and two injury databases National Electronic Injury Surveillance System (NEISS), and Safer Products (SP) government database was conducted by two independent auditors. The literature search was performed using the terms “bristle brush,” “grill brush,” and “wire brush.” The injury database search required that all events had one of the following codes linked with it: (41) ingestion, or (56) foreign body, (0) internal, (88) mouth, or (89) neck, (480) household cleaning products, (837) wire unspecified, (3218) charcoal or wood-burning grills, (3229) electric grills, (3248) gas or LP grills or stoves, (3230) kerosene grills or stoves, (3233) other grills or stoves, (3249) grills not specified. Variables of interest included common symptomatology, associated foods, time to presentation, and treatment course.
Results:
A total of 92 cases of wire grill-brush injury were identified; 43 from literature review, 35 from NEISS, and 14 from SP. The combined case list was reviewed and data was extracted. Complete case information was missing in a majority of patients, but in general, genders were affected equally and 10% of patients were under 19 years of age. The most common foods were hamburgers and grilled chicken. The main diagnostic imaging tests were CT scan (38%), and XR (29.3%). Of the known 58 cases 22.4% required intervention using a combination of laryngoscopy, endoscopy and surgery. Operative management alone was used in 23 (39.7%), whereas 6 (10.3%) were treated by laryngoscopy alone and 6 (10.3%), endoscopy alone. The majority of known cases (18, 58.0%) presented over 24 hours after suspected ingestion; of those, 7 (22.6%) presented over 1 week after suspected ingestion. Injuries involving the head and neck were more frequent (53.2%) than abdominal injuries (23.9%), and a significant amount of the injuries were unknown/unlisted (22.8%). Neck exploration occurred in 6.8%, abdominal surgery (laparoscopy or laparotomy) in 29.3%, laryngoscopy or endoscopy in 27.5%, and 3.4% required multiple operative procedures that resulted in failed retrieval.
Conclusions:
Wire grill-brush associated injuries are variable, and often present with a significant delay after presumed ingestion. Diagnostic imaging modalities are quite variable, and significant proportions of patients treated for ingestion require operative intervention. More information is needed to better characterize rare but perhaps underappreciated injuries stemming from wire grill-brush ingestion, and to better inform prevention strategies.