title: Emerging battery-ingestion hazard: clinical implications.
abstract: OBJECTIVE
  Recent cases suggest that severe and fatal button battery ingestions are increasing and current treatment may be inadequate. The objective of this study was to identify battery ingestion outcome predictors and trends, define the urgency of intervention, and refine treatment guidelines.
  
  
  METHODS
  Data were analyzed from 3 sources: (1) National Poison Data System (56535 cases, 1985-2009); (2) National Battery Ingestion Hotline (8648 cases, July 1990-September 2008); and (3) medical literature and National Battery Ingestion Hotline cases (13 deaths and 73 major outcomes) involving esophageal or airway button battery lodgment.
  
  
  RESULTS
  All 3 data sets signal worsening outcomes, with a 6.7-fold increase in the percentage of button battery ingestions with major or fatal outcomes from 1985 to 2009 (National Poison Data System). Ingestions of 20- to 25-mm-diameter cells increased from 1% to 18% of ingested button batteries (1990-2008), paralleling the rise in lithium-cell ingestions (1.3% to 24%). Outcomes were significantly worse for large-diameter lithium cells (> or = 20 mm) and children who were younger than 4 years. The 20-mm lithium cell was implicated in most severe outcomes. Severe burns with sequelae occurred in just 2 to 2.5 hours. Most fatal (92%) or major outcome (56%) ingestions were not witnessed. At least 27% of major outcome and 54% of fatal cases were misdiagnosed, usually because of nonspecific presentations. Injuries extended after removal, with unanticipated and delayed esophageal perforations, tracheoesophageal fistulas, fistulization into major vessels, and massive hemorrhage.
  
  
  CONCLUSIONS
  Revised treatment guidelines promote expedited removal from the esophagus, increase vigilance for delayed complications, and identify patients who require urgent radiographs.
authors.affiliation: National Capital Poison Center, 3201 New Mexico Ave, Suite 310, Washington, DC 20016, USA. toby@poison.org
authors.forename: Toby
authors.initials: T
authors.lastname: Litovitz
authors.forename: Nicole
authors.initials: N
authors.lastname: Whitaker
authors.forename: Lynn
authors.initials: L
authors.lastname: Clark
authors.forename: Nicole C
authors.initials: NC
authors.lastname: White
authors.forename: Melinda
authors.initials: M
authors.lastname: Marsolek
mesh_terms: D016208:Databases, Factual; D011211:Electric Power Supplies / Q000009:adverse effects*; D004572:Electrolysis; D004867:Equipment Design; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D005547:Foreign Bodies / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D014218:Triage; D014481:United States / Q000453:epidemiology