title: Identifying predictive factors for long-term complications following button battery impactions: A case series and literature review.
abstract: OBJECTIVE
  To complement a case series review of button battery impactions managed at our single military tertiary care center with a thorough literature review of laboratory research and clinical cases to develop a protocol to optimize patient care. Specifically, to identify predictive factors of long-term complications which can be used by the pediatric otolaryngologist to guide patient management after button battery impactions.
  
  
  METHODS
  A retrospective review of the Department of Defense's electronic medical record systems was conducted to identify patients with button battery ingestions and then characterize their treatment course. A thorough literature review complemented the lessons learned to identify potentially predictive clinical measures for long-term complications.
  
  
  RESULTS
  Eight patients were identified as being treated for button battery impaction in the aerodigestive tract with two sustaining long-term complications. The median age of the patients treated was 33 months old and the median estimated time of impaction in the aerodigestive tract prior to removal was 10.5 h. Time of impaction, anatomic direction of the battery's negative pole, and identifying specific battery parameters were identified as factors that may be employed to predict sequelae.
  
  
  CONCLUSIONS
  Based on case reviews, advancements in battery manufacturing, and laboratory research, there are distinct clinical factors that should be assessed at the time of initial therapy to guide follow-up management to minimize potential catastrophic sequelae of button battery ingestion.
authors.affiliation: Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA. Electronic address: mitcheliason@hotmail.com.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eliason
authors.affiliation: Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Melzer
authors.affiliation: Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Winters
authors.affiliation: Naval Medical Center Portsmouth, Department of Otolaryngology, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA.
authors.forename: Thomas Q
authors.initials: TQ
authors.lastname: Gallagher
mesh_terms: D002648:Child; D002675:Child, Preschool; D004424:Ear Canal; D004435:Eating; D011211:Electric Power Supplies; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D058753:Laryngoplasty; D008297:Male; D009296:Nasal Cavity / Q000000981:diagnostic imaging / Q000601:surgery; D061270:Nasal Septal Perforation / Q000209:etiology*; D011859:Radiography; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000601:surgery
keywords: Aerodigestive tract; Aspiration; Button battery; Esophageal foreign body; Predictive factors; Quantum Tunneling Composite Coating (QTCC)