Patient characteristics, outcomes and hospital-level healthcare costs of foreign body ingestion from an Australian, non-prison referral centre.

OBJECTIVE: Foreign body ingestion (FBI) occurs infrequently but can be associated with rare risks including perforation. There is limited understanding of the impact of adult FBI in Australia. We aim to evaluate patient characteristics, outcomes and hospital costs of FBI. DESIGN: A retrospective cohort study of patients with FBI was performed at a non-prison referral centre in Melbourne, Australia. International Classification of Disease-10 coding identified patients with gastrointestinal FBI over financial years 2018-2021. Exclusion criteria were food bolus, medication foreign body, object in anus or rectum, or non-ingestion. Criteria for 'emergent' classification were oesophagus, size >6 cm, disc batteries, airway compromise, peritonitis, sepsis and/or suspected viscus perforation. RESULTS: Thirty-two admissions attributed to 26 patients were included. The median age was 36 years (IQR: 27-56), 58% were male and 35% had a prior psychiatric or autism spectrum disorder. There were no deaths, perforations or surgery. Gastroscopy was performed in 16 admissions and 1 was scheduled following discharge. Rat-tooth forceps were used in 31% and an overtube was used in 3 cases. The median time from presentation to gastroscopy was 673 minutes (IQR: 380-1013). Management was adherent to European Society of Gastrointestinal Endoscopy guidelines in 81%. After excluding admissions with FBI as a secondary diagnosis, median admission cost was $A1989 (IQR: $A643-$A4976) and total admission costs over the 3 years was $A84 448. CONCLUSION: FBI in an Australian, non-prison referral centre is infrequent, can often be safely managed expectantly, and has limited impact on healthcare utilisation. Early, outpatient endoscopy could be considered for non-urgent cases, which may reduce costs while maintaining safety.

The effectiveness of radiofrequency scanning technology in preventing retained surgical items: An integrative review.

AIMS AND OBJECTIVES: To synthesise evidence on the effectiveness of radiofrequency (RF) scanning technology as an adjunct to manual counting protocols in preventing retained surgical items (RSIs) in the operating room. BACKGROUND: Despite the implementation of rigorous manual counting protocols, RSIs remain one of the most common reported sentinel events in operating theatres that lead to adverse patient outcomes. DESIGN: An integrative review. METHODS: This review was guided by the Whittemore and Knafl (2005) framework. A literature search using CINAHL, MEDLINE, ProQuest, PubMed, and Scopus with key search terms related to RSIs and RF was applied to select English articles from January 2011 till August 2021. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was utilised for study quality assessment while reporting of review was guided using the PRISMA checklist. RESULTS: A total of 15 peer-reviewed articles were included, enabling the knowledge on the RF scanning technology to be grouped into four themes, namely: detection accuracy of RF scanning technology, real-time detection of surgical items using RF identification, the impact of the RF scanning technology for detecting RSIs on patient safety, and cost-analysis of integrating the RF scanning technology in operating theatres. CONCLUSION: Radiofrequency scanning technology is effective in preventing RSIs with significant cost-savings. Perioperative leaders should develop a multidisciplinary process to evaluate and select the most appropriate RF scanning technology as part of their patient safety programs. However, future studies with a larger sample size and robust research design, such as randomised controlled trial, should be considered to enhance the generalisability and rigour of evidence. RELEVANCE TO CLINICAL PRACTICE: This review contributes to perioperative personnel's education/training of staff on using RF scanning technology to prevent RSIs. The cost-effectiveness analysis enables the healthcare leaders to decide on the selection of appropriate RF technology.

Comparison of Cap-Assisted vs Conventional Endoscopic Technique for Management of Food Bolus Impaction in the Esophagus: Results of a Multicenter Randomized Controlled Trial.

INTRODUCTION: "Push" or "pull" techniques with the use of snares, forceps, baskets, and grasping devices are conventionally used to manage esophageal food bolus impaction (FBI). A novel cap-assisted technique has recently been advocated to reduce time taken for food bolus (FB) removal. This study aimed to compare the effectiveness of the cap-assisted technique against conventional methods of esophageal FB removal in a randomized controlled trial. METHODS: Consecutive patients with esophageal FBI requiring endoscopic removal, from 3 Australian tertiary hospitals between 2017 and 2019, were randomized to either the cap-assisted technique or the conventional technique. Primary outcomes were technical success and FB retrieval time. Secondary outcomes were technical success rate, en bloc removal rate, procedure-related complication, length of hospital stay, and cost of consumables. RESULTS: Over 24 months, 342 patients with esophageal FBI were randomized to a cap-assisted (n = 171) or conventional (n = 171) technique. Compared with the conventional approach, the cap-assisted technique was associated with (i) shorter FB retrieval time (4.5 ± 0.5 minutes vs 21.7 ± 0.9 minutes, P < 0.001), (ii) shorter total procedure time (23.0 ± 0.6 minutes vs 47.0 ± 1.3 minutes, P < 0.0001), (iii) higher technical success rate (170/171 vs 160/171, P < 0.001), (iv) higher rate of en bloc removal (159/171 vs 48/171, P < 0.001), and (v) lower rate of procedure-related mucosal tear and bleeding (0/171 vs 13/171, P < 0.001). There were no major adverse events or deaths within 30 days in either group. The total cost of consumables was higher in the conventional group (A$19,644.90 vs A$6,239.90). DISCUSSION: This multicenter randomized controlled trial confirmed that the cap-assisted technique is more effective and less costly than the conventional approach and should be first-line treatment for esophageal FBI.

Microimplantation of foreign materials for assessment of foreign body immune responses and granuloma formation in zebrafish larvae.

This protocol describes the microimplantation of foreign materials such as schistosome eggs, polymer beads, and other microscopic objects into the small and optically transparent larval zebrafish for the assessment of immune responses, including granuloma formation. This protocol has wide applicability for both fundamental studies on host responses to parasite eggs and other foreign bodies, as well as the testing of potential biomaterials and devices used for human medical implants. For complete details on the use and execution of this protocol, please refer to Takaki et al. (2021a) and (2021b).

Competency-Based Assessment Tool for Pediatric Esophagoscopy: International Modified Delphi Consensus.

OBJECTIVES/HYPOTHESIS: Create a competency-based assessment tool for pediatric esophagoscopy with foreign body removal. STUDY DESIGN: Blinded modified Delphi consensus process. SETTING: Tertiary care center. METHODS: A list of 25 potential items was sent via the Research Electronic Data Capture database to 66 expert surgeons who perform pediatric esophagoscopy. In the first round, items were rated as "keep" or "remove" and comments were incorporated. In the second round, experts rated the importance of each item on a seven-point Likert scale. Consensus was determined with a goal of 7 to 25 final items. RESULTS: The response rate was 38/64 (59.4%) in the first round and returned questionnaires were 100% complete. Experts wanted to "keep" all items and 172 comments were incorporated. Twenty-four task-specific and 7 previously-validated global rating items were distributed in the second round, and the response rate was 53/64 (82.8%) with questionnaires returned 97.5% complete. Of the task-specific items, 9 reached consensus, 7 were near consensus, and 8 did not achieve consensus. For global rating items that were previously validated, 6 reached consensus and 1 was near consensus. CONCLUSIONS: It is possible to reach consensus about the important steps involved in rigid esophagoscopy with foreign body removal using a modified Delphi consensus technique. These items can now be considered when evaluating trainees during this procedure. This tool may allow trainees to focus on important steps of the procedure and help training programs standardize how trainees are evaluated. LEVEL OF EVIDENCE: 5. Laryngoscope, 131:1168-1174, 2021.

Button battery exposures in Australian children: a prospective observational study highlighting the role of poisons information centres.

CONTEXT: Button battery ingestion is a worldwide problem, with evidence of increasing harms and deaths in recent decades. Australian Poisons Information Centre (PIC) experience includes cases of treatment delay due to lack of healthcare professional recognition of risks, and/or lack of local resources. This study aims to characterise Australian button battery exposures, focusing on exposure circumstances, and preventable health system shortcomings. METHODS: A prospective observational study of button battery exposure calls to New South Wales PIC, November 2015-May 2017, using a follow-up survey to obtain outcome data and additional details. Survey data was combined with nationwide PIC data over the same period. RESULTS: Australian PICs were consulted on 578 exposures over the 19-month study period, including 506 paediatric cases. The median (IQR) age for the paediatric cases was 23 months (14-36 months). Where the source was identified, batteries came from toys in 26% of cases, with hearing aids, watches, and remote controls being other common sources. Children in outer regional, remote and very remote areas were overrepresented, and 15 cases were referred to a different hospital due to X-ray facilities being unavailable at their nearest hospital. We identified inconsistent triage from a range of first responders, and knowledge gaps regarding button battery dangers amongst some healthcare professionals. DISCUSSION: Button battery exposures are a common call to Australian PICs. This study highlights a potential role of education campaigns, professional guidelines, and child-resistant battery compartments in toys and household devices. PICs calling ahead to ensure X-ray availability/diversion to a different hospital likely reduced delays for this time-critical exposure. CONCLUSIONS: Button battery exposures continue to be a problem in Australia. Data collected by PICs can provide useful information for public health and product safety initiatives. A PIC-led protocol to direct initial medical management of button battery exposures could reduce delays and improve outcomes.

Prolonged Vaginal Bleeding in an Adolescent Secondary to a Foreign Body: Need for a Comprehensive Assessment and Complex Surgery.

BACKGROUND: Heavy, prolonged menstrual bleeding is common in adolescents and results from a variety of etiologies. CASE: A 13-year-old, virginal girl was referred for prolonged, heavy vaginal bleeding despite combined oral contraceptive use and elected management with a levonorgestrel intrauterine device. A preprocedure exam revealed a plastic foreign body embedded in the posterior vaginal fornix, however, attempted removal in the office was unsuccessful. Subsequent computed tomography imaging of the pelvis revealed a vaginal foreign body, complex adnexal mass, and hydroureter. The patient underwent exam under anesthesia and diagnostic laparoscopy, but required conversion to exploratory laparotomy for removal of a foreign body because of vaginal perforation abutting the rectum. SUMMARY AND CONCLUSION: Foreign bodies not easily removed in the outpatient setting should be considered for surgical removal with consideration of preoperative multidisciplinary coordination when imaging reveals intra-abdominal pathology, such as tubo-ovarian abscess and hydroureter.

Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.

Objectives: This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Methods: Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Results: Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. Conclusions: 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

Evaluation of radiofrequency electronic system in intraoperative monitoring of surgical textiles / Avaliação de sistema eletrônico por radiofrequência para monitoramento intraoperatório de têxteis cirúrgicos

ABSTRACT Objective To test performance of SurgiSafe®, a radiofrequency electronic device to detect surgical textiles during operations as compared to manual counting. Methods Surgical sponges with radiofrequency TAGs were placed in the abdominal cavity of a pig submitted to laparotomy, in randomly distributed sites. The TAGs were counted manually and also using SurgiSafe®. Positive and negative predictive values, sensitivity, specificity and time required for counting were analyzed for both methods. Results Through the analysis of 35 surgical cycles, SurgiSafe® immediately identified all sponges, with specificity, sensitivity, positive and negative predictive values of 100%. Although not statistically significant, the manual count had sensitivity of 99.72% and specificity of 99.90%. Conclusion SurgiSafe® proved to be an effective device to identify surgical sponges in vivo, in real time; and its use as an adjuvant to manual counting is very helpful to increase patient's safety.

RESUMO Objetivo Testar o desempenho do SurgiSafe®, dispositivo eletrônico de detecção de têxteis cirúrgicos por radiofrequência no intraoperatório, comparado à contagem manual. Métodos Gazes com etiquetas de radiofrequência (TAGs) foram alocadas na cavidade abdominal de um suíno submetido à laparotomia, em locais distribuídos aleatoriamente. As TAGs foram contadas manualmente e com uso do SurgiSafe®. Valores preditivos positivos e negativos, sensibilidade, especificidade e tempo de contagem foram analisados para ambos os métodos. Resultados Por meio da análise de 35 ciclos cirúrgicos, o SurgiSafe® fez a identificação instantânea de todas as gazes, com especificidade, sensibilidade, valores preditivos negativo e positivo de 100%. Apesar de não apresentar significância estatística, a contagem manual apresentou sensibilidade de 99,72% e especificidade de 99,90%. Conclusão O SurgiSafe® mostrou-se eficaz para contabilização de têxteis cirúrgicos em tempo real in vivo, e seu uso como adjuvante na contagem manual é de grande valor para o aumento de segurança do paciente.

Ocular Gossypiboma: Ultrasound B-Scan Assessment of Retained Surgical Sponge After Ahmed Valve Surgery: A Case Report.

PURPOSE OF THE STUDY: To present the first documented case of an ocular gossypiboma (retained foreign body) of a mitomycin-C-soaked sponge confirmed echographically using diagnostic ultrasound B-scan after Ahmed valve surgery. PATIENTS AND METHODS: A patient who underwent phacoemulsification with Ahmed valve implantation surgery had a retained Weck-Cels sponge soaked with mitomycin-C. With the use of ocular ultrasound B-scan, the retained sponge was localized and a second procedure was performed to explant it. CONCLUSION: In cases of ocular gossypiboma the use of ultrasound modalities can be a valuable tool especially because B-scan access is common and can be cost-effective.

Nasal foreign bodies in children in a pediatric hospital in Senegal: A three-year assessment.

OBJECTIVES: Nasal foreign bodies (NFB) constitute a common domestic accident in children. The objectives of the present study were to report the particularities of NFBs in children presenting at a pediatric hospital in Senegal, and to describe our therapeutic attitude. MATERIAL AND METHODS: A retrospective descriptive study included all under-15 year-olds presenting with NFB in the ENT department of the National Children's Hospital Center of Diamniadio, Senegal, between January 1, 2013 and December 31, 2015. Study variables comprised: age, gender, provenance, presenting symptoms, time to consultation, type of NFB, extraction method, and complications. RESULTS: 58 NFB cases were retrieved. Mean age was 3years 4months; 93% of patients were under 5 years old. There was female predominance of 53.45%: i.e., sex-ratio, 0.87. Location was in the right cavity in 43 patients (74.1%). The presenting symptom was purulent rhinorrhea in 51.7% of cases. Time to consultation was within 24hours in 17.24% of cases. NFB type was firstly foam rubber (29.3%), followed by grain (20.7%). Extraction was performed in consultation in 84.5% of cases and in the operating room in 15.5%. Morbidity was 22.41%: 17.24% epistaxis and 5.17% nasal infection. CONCLUSION: NFBs constitute a common domestic accident in under-5 year-olds. The rural Senegalese context shows delay in consultation.

Comparative Sensitivity Assessment of Cone Beam Computed Tomography and Digital Radiography for detecting Foreign Bodies.

AIM: Foreign body detection and determining whether it is adjacent to critical organs has a significant role in its removal. Various imaging techniques have been used to locate foreign bodies. This study aimed to compare cone beam computed tomography (CBCT) and digital radiography for detecting foreign bodies in an in vitro model. MATERIALS AND METHODS: Foreign bodies composed of normal glass, barium glass, wood, and stone with two sizes were placed into three different locations of two sheep heads. Digital radiography [lateral cephalometric, submentovertex (SMV)] and CBCT were compared to investigate their sensitivity for detecting foreign bodies. RESULTS: Diagnostic sensitivity of digital radiography in lateral cephalometric view, SMV view, and CBCT for detecting all types of foreign bodies was 67.2, 32.3, and 76.6% respectively. None of these techniques were successful in detecting wood satisfactory. Stone was detected relatively higher than other foreign bodies (82.6%). Diagnostic sensitivity of CBCT in detecting foreign bodies was 100%, except for wood. Accuracy of imaging techniques in detecting foreign bodies according to locations in descending order was lip, mandibular angle, and maxillary sinus. CONCLUSION: It can be concluded that appropriate amount of radiopacity is enough for CBCT to exactly detect foreign body, regardless of its location or size. CLINICAL SIGNIFICANCE: In maxillofacial traumatic patients, CBCT seems to be a better and cost-effective technique for detecting hidden foreign bodies than other routine techniques.

Assessment of the management outcomes of body packers.

BACKGROUND: The constant need for rapid financial gain drives the international illegal drug industry, which encourages healthy individuals to smuggle drugs through internal concealment. The aim of this study was to evaluate our practice of the management of body packers using a hospital-based protocol in order to validate it. METHODS: Electronic hospital data were retrospectively reviewed between 2000 and 2013 of all patients that were admitted to Hillingdon Hospital with a history of internal drug concealment. Demographic as well as clinical data including investigations and management were collected. RESULTS: One hundred and twenty patients were admitted over the study period to our surgical unit. This included 86 male and 34 female patients with a mean age of 38 (range 19-64) years. Three per cent (n = 4) underwent surgery for either cocaine toxicity or obstruction. The rest of the patients were managed conservatively with bowel cleansing preparations to encourage the natural passage of drug packages. CONCLUSION: Conservative treatment is safe and effective for drug body packers. We therefore recommend conservative management to be the mainstay for body packers with surgery only being indicated on clinical grounds.

Vesicovaginal Fistula in Adolescent Girls: Incidence and Management.

BACKGROUND: The purpose of the study was to analyze the incidence, causes, and management of vesicovaginal fistula (VVF) in adolescent girls. CASES: Three girls of adolescent age were diagnosed with VVF, caused by a vaginal foreign body (ie, an aerosol spray cap). Transvesical reconstruction was performed in 2 cases. After the diagnosis of VVF, the third girl was discharged home with Foley catheter drainage. Three months later, she presented with pregnancy and was lost to follow-up. SUMMARY AND CONCLUSION: Evaluation of unusual urinary symptoms in an adolescent should include vaginal examination and/or imaging. Aerosol spray caps remain the most common vaginal foreign body resulting in VVFs in adolescent girls in Lithuania. Transvesical reconstruction is safe and efficient.

Surgical management and morbidity of pediatric magnet ingestions.

BACKGROUND: Foreign body ingestion remains a common reason for emergency room visits and operative interventions in the pediatric population. Rare earth magnet ingestion represents a low percentage of all foreign bodies swallowed by children; however, magnets swallowed in multiplicity can result in severe injuries. MATERIALS AND METHODS: Pediatric surgeons with membership in the Surgical Section of the American Academy of Pediatrics were surveyed to determine the magnitude and consequences of magnet ingestions in the pediatric population. RESULTS: About 100 (16%) participant responses reported on 99 magnet ingestions. The median age at ingestion was 3.7 y, and the majority of ingestions (71%) occurred after year 2010. Thirty-two children underwent endoscopy with successful removal in 70% of cases, and multiple magnets were found in 65% of these patients. Seventy-three children required either laparotomy (51) or laparoscopy (22) for magnet removal, and 90% of these children were discovered to have ingested more than one magnet. In addition, 17% of the children were found to have at least one perforation or fistula, and 34% of the children had multiple perforations or fistulae. Nine children required long-term care for their injuries including repeat endoscopies. One child died after hemorrhage from an esophago-aortic fistula. CONCLUSIONS: These results demonstrated the increasing need for magnet regulations and public awareness to prevent potentially serious complications.

Retained foreign bodies: risk and outcomes at the national level.

BACKGROUND: Retained foreign bodies (RFB) after operative interventions are linked to an increased risk of morbidity and mortality, and represent a medico-legal liability. We aimed to identify associated risk factors and outcomes related to iatrogenic RFB in the United States. STUDY DESIGN: A cross-sectional analysis was performed on all interventions that resulted in a secondary diagnosis of RFB in the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Comparative controls were randomly selected from patients who underwent similar procedures. RESULTS: We identified 3,045 cases of RFB, and 12,592 controls were included. The majority of incidents, 968 (31.8%), were reported after gastrointestinal interventions. Risk of RFB was higher in teaching hospitals (odds ratio [OR] 1.31, 95% CI [1.19, 1.45], p < 0.001). For abdominopelvic procedures, patients admitted with traumatic injuries did not demonstrate a higher risk of RFB compared with electively admitted patients (OR 1.70, 95% CI [0.94, 3.07], p = 0.08). However, for procedures unrelated to abdominopelvic surgery, patients admitted for trauma had a lower risk (OR 0.62, 95% CI [0.50, 0.78], p < 0.001). Obesity (BMI ≥ 30 kg/m(2)) and older age (≥ 65 years) were significantly associated with a higher risk only for abdominopelvic procedures (p < 0.01 for both). Retained foreign bodies were associated with a higher average cost of health services ($26,678.00 ± $769.69 vs $12,648.00 ± $192.80, p < 0.001). CONCLUSIONS: Retained foreign bodies have unfavorable and nationally tangible clinical and economic outcomes. The risk profile for RFB at the national level seems to demonstrate an association with demographic and clinical factors including nature of the procedure, type of admission, and trauma status. Teaching hospitals are associated with a higher risk. Targeted efforts toward identified high-risk populations are needed to avoid these morbid and costly complications.

Retained surgical sponges: findings from incident reports and a cost-benefit analysis of radiofrequency technology.

BACKGROUND: Retained surgical items (RSIs) are serious events with a high potential to harm patients. It is estimated that as many as 1 in 5,500 operations result in an RSI, and sponges are most commonly involved. The adverse outcomes, additional medical care needed, and medico-legal costs associated with these events are substantial. The objective of this analysis was to advance our understanding of the occurrence of RSIs, the methods of prevention, and the costs involved. STUDY DESIGN: Incident reports entered into the University HealthSystem Consortium (UHC) Safety Intelligence database on incorrect surgical counts and RSIs were analyzed. Reported cases of retained surgical sponges at organizations that use radiofrequency (RF) technology and those that do not were compared. A cost-benefit analysis on adopting RF technology was conducted. RESULTS: Five organizations that implemented RF technology between 2008 and 2012 collectively demonstrated a 93% reduction in the rate of reported retained surgical sponges. By comparison, there was a 77% reduction in the rate of retained sponges at 5 organizations that do not use RF technology. The UHC cost-benefit analysis showed that the savings in x-rays and time spent in the operating room and in the medical and legal costs that were avoided outweighed the expenses involved in using RF technology. CONCLUSIONS: Current standards for manual counting of sponges and the use of radiographs are not sufficient to prevent the occurrence of retained surgical sponges; our data support the use of adjunct technology. We recommend that hospitals evaluate and consider the use of an adjunct technology.

Delayed presentation of an undiscovered nasopharyngeal foreign body.

Suspected paediatric aerodigestive tract foreign body (FB) ingestion or aspiration is a commonly encountered emergency. Management may require a general anaesthetic for retrieval with bronchoscopy, laryngoscopy and oesophagoscopy, each dependent on the history and investigations of the case in question. We describe the case of a foreign body, which was missed in the nasopharynx for more than 3 years and also discuss how pressures on National Health Service (NHS) referral and follow-up patterns may have altered the time course of the eventual discovery.

A case for early bronchoscopic airway assessment after disc battery ingestion.

Disc battery ingestion in children is becoming increasingly common with the proliferation of small battery-powered electronic devices. In the case of esophageal impaction, the likelihood and severity of complications are proportionate to the time between ingestion and removal. Tracheo-esophageal fistulae (TOF) are a recognized complication and can be life-threatening. We describe an interesting case of disc battery ingestion with delayed recognition of a TOF. We document the tracheal mucosal healing process of a large airway defect and describe the role of bronchoscopy in guiding the timing of surgical intervention. This case highlights the important role of early bronchoscopic assessment in management of these patients.