The Dark Side of the Force Rises: Uptrends of Button Battery and Magnet Ingestions by Children Two Years into the Covid-19 Pandemic

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.