Risk factors and outcomes for foreign body left during a procedure: analysis of 413 incidents after 1 946 831 operations in children.

OBJECTIVE: To determine risk factors and outcomes associated with a foreign body left during a procedure in a population of pediatric surgical patients. DESIGN: Case-control study. SETTING: The Nationwide Inpatient Sample and Kids' Inpatient Database were used to identify hospitalized pediatric surgical patients in the United States (aged 0-18 years) from 1988 to 2005. PATIENTS: After data from 1 946 831 hospitalizations in children were linked to the Agency for Healthcare Research and Quality Pediatric Quality Indicator (PDI) software, 413 pediatric patients with foreign bodies left during a procedure (PDI 3) were identified. A 1:3 matched case-control design was implemented with 413 cases and 1227 controls. Cases and controls were stratified into procedure categories based on diagnosis related group procedure codes. MAIN OUTCOME MEASURES: To examine the relationship between PDI 3 and procedure category, as well as the outcomes of in-hospital mortality, length of stay, and total hospital charges. RESULTS: Logistic regression analysis revealed a statistically significant higher odds of PDI 3 in the gynecology procedure category (odds ratio, 4.13; P = .01). Multivariable regression analysis revealed that patients with PDI 3 had an 8-day longer length of stay (95% confidence interval, 5.6-10.3 days; P < .001) and $35 681 higher total hospital charges (95% confidence interval, $22 358-$49 004; P < .001) but were not more likely to die (odds ratio, 1.07; P = .92). CONCLUSIONS: Among pediatric surgical admissions, a foreign body left during a procedure was observed to occur with highest likelihood during gynecologic operations. The occurrence of this adverse event was associated with longer length of stay and greater total hospital charges, but not with increased mortality.

Lower respiratory tract foreign bodies: a retrospective review of morbidity, mortality and first aid management.

OBJECTIVES: The authors describe 28 pediatric cases of foreign body inhalation requiring treatment in intensive care units between 1987 and 1999. The purpose of this study was: (1) to analyze the circumstances, diagnostic difficulties and initial treatment of serious foreign bodies and (2) to compare our series with other literature descriptions and define principles for optimal prevention and initial treatment. METHODS: Twenty-one children presented a penetration syndrome, which was responsible in 13 cases for asphyxia with cardiorespiratory arrest. All these children died, regardless of the initial treatment. Seven children were hospitalized for apparent asthmatic symptoms that did not respond to traditional treatment. RESULTS: The inefficiency of external extraction methods like the Heimlich maneuver and the mean delay between clinical signs and initial treatment lead us to propose a new strategy for the emergency treatment of foreign bodies with asphyxia. CONCLUSIONS: We recommend that emergency teams promote the use of a laryngoscope and Magill forceps. Flexible endoscopy is still recommended as the appropriate diagnostic tool to eliminate doubt in the case of a first severe asthma attack.

Prevention of traumatic indigestion in cattle.

The incidence of traumatic indigestion in an industrialised agricultural country, the economic losses due to the disease, and its prevention by use of a permanent reticular magnet are reviewed.