ABSTRACT
Background Foreign body ingestion among children is a well-known, potentially hazardous injury that can prove fatal. We recently reported on trends in foreign body ingestions during the first year of the pandemic. This study aims to investigate whether the trends seen during the first year of the pandemic in the setting of stay-at-home orders, including decreases in foreign body ingestions at school and increase in danger foreign body ingestions (button batteries and magnets) continued into the second year of the pandemic. Methods We used the National Electronic Injury Surveillance System (NEISS) database to evaluate the frequency of suspected-foreign body ingestions (FBI) in children ages 0-17 years of age for years 2017-2021. For the purposes of our analyses, we identified 2017-2019 and 2020-2021 as the pre-COVID-19 and COVID-19 periods, respectively. FBI frequencies were then annualized based on the number of years contained within each period. We used the NEISS coding manual to assign classes to the consumer products implicated in FBI including: electronics (including cylindrical and button batteries), magnets, coins, toys, desk supplies, bathroom items, jewelry, fasteners (screws, nails, etc.) and holiday items (Christmas ornaments, holiday decor, etc.). Escalation of care was defined as hospital admission or transfer. All reported values are populations national estimates generated from actual FBI encounters at NEISS sampled emergency rooms and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons. Logistic regression modeling was used for comparison of continuous variables. Results The majority of FBI occurred in children age 0-5 years. During the COVID period, 56% of ingestions occurred in males. There was no significant increase in estimated total FBI between the pre-COVID-19 and COVID period (55,175 (95% confidence intervals (95% CI) 39,329-71,020) vs 54,325 (95% CI 37,880-70,769), P=0.06). The estimated number of ingestions occurring in school decreased from pre-COVID-19 (2,306 (95% CI 1,635-2,976)) compared to COVID-19 (1,327(95% CI 640-2,015), P=0.07). The estimated number of children requiring escalation of care due to FBI increased between the two time periods (6,375 (95% CI 4,167-8,583) vs 7,508 (95% CI 4,673-10,343);p=0.8) (table 1). The estimated frequency of magnet ingestions increased significantly between the two time periods (2,603 (95% CI 1,627-3,579) vs 4,481 (95% CI 2,982-5,890), P<0.0001). The number of multiple magnet ingestions also increased (738 (95% CI 371-1,106) vs 1,355 (95% CI 841-1,869), P<0.0001). The number of estimated button battery ingestions also increased (300 (95% CI 101-498) vs 510 (95% CI 283-738), P<0.01) (figure 1). Conclusion While there was no significant increase in the frequency of total foreign body ingestions during the pandemic, the proportion of the most dangerous ingestion subtypes (magnets and button batteries) and the need for care escalation increased significantly. The injury patterns described in this analysis, provides an opportunity for targeted advocacy and education of patients, parents, educators, caregivers, and policymakers. This should guide future pandemic public health campaigns to increase home safety and prevent harmful FBI.
ABSTRACT
Purpose/Objectives: Clinical clerkship curricula should exist to provide rotating learners on subspecialty rotations with consistent exposure to specific topics geared towards the discipline of interest, such as Pediatric Gastroenterology (GI). In the spring of 2020, the COVID-19 pandemic forced the medical community to pivot to both virtual patient care and medical education. Many teachers were forced to transition their curricula away from traditional, in-person didactics to asynchronous, on-line learning. We developed the Digital Interactive Gastroenterology Education Suite for Trainees (DIGEST) a novel pediatric gastroenterology curriculum on GOOGLE classroom for rotating learners. Our aims were to assess the curriculum and to study learning outcomes amongst trainees. Design/Methods: A general needs assessment in 2019 identified a lack of standardized educational experience amongst the rotating learners on Pediatric GI service. We developed DIGEST to provide a standardized educational experience for all learners. Our resource acquisition method included interrogation of the Pediatrics in Review (PIR) subject collections, review of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) CPG repository, and a search for topics of interest on MedEd Portal. We organized these resources using a simple, subject-based (i.e. Constipation) format for the classroom: Required readings, Supplemental (optional) readings, Videos & Podcasts and simulations (Figure 1). Next, a “Rotation Passport” was created to guide learners' expectations during the rotation, to facilitate a balance between educational activities and patient care, and to eliminate differences in educational exposures, or clinical opportunities which could be affected by seasonal variations in disease processes or presentations. DIGEST addressed procedural skills using low-fidelity human patient simulation (LFHPS) scenarios from MedEd Portal including: nasogastric tube placement, gastrostomy replacement, and abdominal radiograph interpretation. The COVID-19 pandemic compelled us to transition this program from our departments' secure share drive to the GOOGLE classroom. Learners assessed DIGEST and the LFHPS using the physician assistant clinical rotation evaluation (PACRE) instrument and the Student Satisfaction and Self-Confidence in Learning scale (SSSCL), respectively. We targeted a composite score > 4 (Likert scale 1- 5;1-Strongly Disagree, 5-Strongly Agree) for all questions. Finally, the curriculum quality of DIGEST was evaluated by a Health Professions Education expert using the Course Review Report Rubric. Results: 7 possible learners participated and responded to the questionaires (100% response rate). Learners reported a superior learning experience and increased confidence with DIGEST (Table 1). The HPE expert reported that the course design of DIGEST met or exceeded expectations in all categories. Conclusion/Discussion: DIGEST is a novel pediatric gastroenterology curriculum for rotating learners could be easily deployed, or replicated, for civilian Pediatric GI divisions to use with their learners or expanded on a larger platform to enhance learning for a wider audience. (Table Presented).
ABSTRACT
Background: Foreign body ingestion among children is a wellknown, potentially hazardous injury that can prove fatal. A recent single-center report demonstrated an increased frequency of caustic/toxic ingestions during the pandemic, but the trend in foreign body ingestions has yet to be evaluated. Our study aims to investigate whether the stay-at-home order during the COVID-19 pandemic associated with an increase in foreign body ingestion frequency. Methods: We used the National Electronic Injury Surveillance System (NEISS) database to evaluate the frequency of suspected-foreign body ingestions (FBI) in children ages 0-17 years of age for years 2017-2020. For the purposes of our analyses, we identified 2017-2019 and 2020 as the pre-COVID-19 and COVID-19 periods, respectively. FBI frequencies were then annualized based on the number of years contained within each period. We used the NEISS coding manual to assign classes to the consumer products implicated in FBI including: electronics (including cylindrical and button batteries), magnets, coins, toys, desk supplies, bathroom items, jewelry, fasteners (screws, nails, etc.) and holiday items (Christmas ornaments, holiday décor, etc.). Escalation of care was defined as hospital admission or transfer. All reported values are populations national estimates generated from actual FBI encounters at NEISS sampled emergency rooms and were calculated using the NEISS-supplied weights and variance variables. Rao-Scott Chi-square was used for all categorical comparisons. Results: The majority of FBI occurred in children age 0-5 years. During the COVID period, 57% of ingestions occurred in males. There was no significant decrease in estimated total FBI between the pre-COVID-19 and COVID period (59,933 (95% confidence intervals (95% CI) 42,978-76,888) vs 54,926 (95% CI 39,532-70,319);P=0.06).The estimated number of ingestions occurring in school decreased from pre-COVID-19 (2,678 (95% CI 1,855-3,501)) compared to COVID-19 (1,189 (95% CI 579-1,800), P=0.008). The estimated number of children requiring escalation of care due to FBI increased between the two time periods (6,923 (95% CI 4,605-9,241) vs 8,041 (95% CI 5,305-10,777);p=0.0016). The estimated frequency of magnet ingestions increased significantly between the two time periods (2,891 (95% CI 1,861-3,921) vs 4,816 (95% CI 3,213-6,419), P<0.0001).The number of estimated electronics FBI also increased significantly (5,757 (95% CI 3,833-7,681) vs 6,881 (95% CI 4,417-9,344), P=0.001). Conclusion: While there was no significant increase in the frequency of total foreign body ingestions during the pandemic, the proportion of the most dangerous ingestion subtypes (magnets and electronics) up trended significantly. As expected, the frequency of FBI that occurred at school significantly decreased. The injury patterns described in this analysis, particularly with respect to electronics and magnets, provides an opportunity for targeted advocacy and education of patients, parents, educators, and other caregivers. This should guide future pandemic public health campaigns to increase home safety and prevent future FBI. (Table Presented).