Button Battery Ingestion and Removal Trends 2010–2015 Versus 2020–2025 at a Tertiary Care Pediatric Center

OBJECTIVES: Button battery (BB) ingestion/insertion is a surgical emergency. We analyzed pediatric BB incidents at our institution between 2010-2015 (TP1) and 2020-2025 (TP2) to identify trends over time and strategies to reduce the duration of exposure. METHODS: All foreign body (FB) operative retrievals during study periods were reviewed. Demographics, characteristics, and outcome data of BB were compared. RESULTS: Sixty-two BB (3.2%) were identified from a total of 1914 FBs. The ratio of BB to all FB incidents increased from 2.3% in TP1 to 4.1% in TP2 (p = 0.03, (20/887 vs 42/1027) as did BB diameter (13.8mm/TP1, to 19.3mm/TP2, p = 0.007). The esophagus was the most common site of impaction (n=32) with 8/TP1 and 24/TP2. Caretaker suspicion of an esophageal BB incident was similar and relatively low between time periods (62.5%/TP1 vs 58.3%/TP2, p = 0.54). Caretaker-estimated esophageal exposure time before emergency department (ED) presentation was long (1404 minutes/TP1 and 3306 minutes/TP2, p = 0.72) and accounted for 85.7% and 94.5% of overall BB exposure time respectively. The decrease inriage-to-OR time between time periods was not significant (233 vs. 192 min, p = 0.16). The odds of shorter overall exposure time were associated with greater patient age (OR = 3.35, p = 0.02) and caretaker suspicion of BB incident (OR = 2.33, p = 0.03). Two-thirds of subjects were discharged < 2 days post-removal following observation alone. Long-term morbidity or mortality occurred in 9.4% (3/32) and included tracheoesophageal fistula (n = 1), esophageal stricture (n = 1), and fatal delayed tracheotomy tube obstruction (n = 1). CONCLUSIONS: BB pediatric ingestions are increasing with a greater proportion involving esophageal impaction and some may be life-threatening. Caregiver-estimated time to ED arrival accounted for 85.7%/TP1 and 94.5%/TP2 of total exposure time demonstrating that exposure duration is primarily driven by delays before ED presentation and not by hospital services. Thus, while clinicians must still expedite retrieval to minimize tissue damage, mitigating total exposure requires targeted public awareness campaigns for caregivers. Efforts prioritizing caregiver prevention and public awareness of emergent nature of BB ingestions may reduce exposure time and improve outcome.