title: Esophageal button battery ingestions: decreasing time to operative intervention by level I trauma activation.
abstract: OBJECTIVE
  The incidence of button battery ingestions is increasing and injury due to esophageal impaction begins within minutes of exposure. We changed our management algorithm for suspected button battery ingestions with intent to reduce time to evaluation and operative removal.
  
  
  METHODS
  A retrospective study was performed to identify and evaluate time to treatment and outcome for all esophageal button battery ingestions presenting to a major children's hospital emergency room from February 1, 2010 through February 1, 2012. During the first year, standard emergency room triage (ST) was used. During the second year, the triage protocol was changed and Trauma I triage (TT) was used.
  
  
  RESULTS
  24 children had suspected button battery ingestions with 11 having esophageal impaction. One esophageal impaction was due to 2 stacked coins. Time from arrival in emergency room to battery removal was 183minutes in ST group (n=4) and 33minutes in TT group (n=7) (p=0.04). One patient in ST developed a tracheoesophageal fistula. There were no complications in the TT group.
  
  
  CONCLUSIONS
  The use of Trauma 1 activations for suspected button battery ingestions has led to more expedient evaluation and shortened time to removal of impacted esophageal batteries.
authors.affiliation: Division of Pediatric Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: robert.russell@childrensal.org.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Russell
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Griffin
authors.affiliation: Division of Emergency Medicine, JW Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weinstein
authors.affiliation: Division of Pediatric Surgery, JW Riley Hospital for Children, Indianapolis, IN, USA.
authors.forename: Deborah F
authors.initials: DF
authors.lastname: Billmire
mesh_terms: D000465:Algorithms; D002675:Child, Preschool; D011211:Electric Power Supplies / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D004947:Esophagus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000209:etiology; D014218:Triage
keywords: Button battery; Esophagus; Level I trauma