title: Resource utilization patterns of pediatric esophageal foreign bodies.
abstract: BACKGROUND
  Ingested foreign bodies are a frequent presentation in pediatric emergency departments. Although some pass spontaneously through the gastrointestinal tract, the majority of esophageal-ingested foreign bodies (EFB) require removal.
  
  
  METHODS
  Kids' Inpatient Database (1997-2009) was used to identify children (aged <20 y) with EFB (International Classification of Diseases, Ninth Revision, Clinical Modification code 935.1). Multivariate logistic regression analyses were constructed to identify predictors of resource utilization.
  
  
  RESULTS
  Overall, 14,767 EFB cases were identified. Most patients were <5 y of age (72%), boys (57%), and non-Caucasian (55%), with a median (interquartile range) length of stay (LOS) of 1 (1) d, and total charges of $11,003 (8503). A total of 11,180 procedures were performed, most commonly esophagoscopy (77%), followed by bronchoscopy (20%), gastroscopy (2%), and rarely surgery (0.8%). By multivariate logistic regression, increased total charges were associated with a diagnosis of esophageal ulceration (odds ratio [OR] = 1.57), esophagoscopy (OR = 1.42), and bronchoscopy (OR = 1.62), all P < 0.001. Total charges also increased with admission to urban nonteaching hospitals (OR = 1.51) versus urban teaching hospitals, P < 0.001. Prolonged LOS (≥1 d) was associated with admission to a hospital in the Midwest (OR = 3.18) and with esophageal ulceration (OR = 2.11) and esophagoscopy (OR = 1.13), P < 0.03. Boys had higher odds of longer hospitalization (OR = 1.21), P < 0.001. Overall hospital mortality was 0.1% (n = 16).
  
  
  CONCLUSIONS
  Most EFB occur in children <5 y of age. Esophageal ulceration, esophagoscopy, and bronchoscopy are associated with increased total charges. Esophageal ulceration, esophagoscopy, and boys are associated with an increased LOS. Surgery and hospital mortality are both extremely rare in children with EFB.
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Laura F
authors.initials: LF
authors.lastname: Teisch
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Jun
authors.initials: J
authors.lastname: Tashiro
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Perez
authors.affiliation: Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
authors.forename: Fernando
authors.initials: F
authors.lastname: Mendoza
authors.affiliation: Division of Pediatric Surgery, DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida. Electronic address: jsola@med.miami.edu.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Sola
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004945:Esophagoscopy / Q000191:economics / Q000706:statistics & numerical data*; D004947:Esophagus; D005260:Female; D005547:Foreign Bodies / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: Foreign bodies; Health resources