Increased Emergency Department Visits for Foreign Body Ingestions Requiring Hospitalizations during the Covid-19 Pandemic in the Pediatric Population

ABSTRACT

Background: Foreign body ingestions (FBI) are most commonly seen in children aged 6 months to 4 years and occur at home. Most foreign bodies pass through the gastrointestinal tract without causing any injury. However, 10-20% of cases require endoscopic intervention and <1% require surgery. On March 4th, 2020, a state of emergency in California was announced in response to the evolving COVID-19 pandemic, including closure of all county public schools on March 13th, 2020, and a shelter-in-place order ceasing all non-essential business and travel on March 16th, 2020. Despite the breadth of data on FBIs prior to the pandemic, and others outlining findings from surgical perspectives or in other countries during the pandemic, there is limited data on FBIs and the COVID-19 pandemic in a US pediatric Level 1 Trauma Center in a state with extended and strict mandated shutdowns. Method(s) We used the National Electronic Injury Surveillance System (NEISS) data set for a single large tertiary center, retrospective analysis of FBI, patient demographics, and patient disposition between 3/16/2019-3/15/2021 to better characterize FBI prior to and during the COVID-19 pandemic. Our primary outcome measure was the number of patients presenting to our emergency department (ED) and admitted to our hospital for FBI. High Risk FBI were events involving button batteries, magnets, lead-based objects, or sharp objects (broken glass, needles, nails). We also conducted a secondary chart review to collect demographic data on FBI patients who required admission. All automatically collected data was qualitatively screened and systematically categorized for more effective data presentation. Result(s) While the overall number of presentations to the ED remained similar (279 to 268), there was a higher rate of admissions (8.9% vs 12.3%) during the pandemic. The average age of patients with an ingestion was 42.5 months pre-pandemic, 52.7 months during pandemic;the average age of patients admitted for an FBI was 35.4 months pre-pandemic, 50.9 months during pandemic. The number of high-risk ingestions during the pandemic (10.8% vs 14.2%) was higher. Of children who needed to be admitted, a greater number required endoscopic procedures during the pandemic (29.9% vs 38.5%). There was also a larger proportion of patients belonging to ethnic minorities (Black, Asian, Hispanic/Latino) that were admitted during the pandemic (45.5% vs 63.0%). Conclusion(s) Both ED and hospital admission data reflect the disruption to the home and work environments that the general population experienced in the pandemic. The increased average age of a FBI-presenting and FBI-admitted patient could reflect the increased incidence in older, possibly school-aged children, in light of the state-wide shutdown of schools and children being at home full-time. The increase in high risk and admission rates in the pandemic also suggests that mandates placing children in the home increase their exposure to harmful materials and increased risk of serious injury requiring invasive procedures. We serve a particularly vulnerable population;the majority of our patients are insured by Medicaid and of lower socioeconomic status (SES), and we would expect that the increase in FBI is correlated to SES. Moving forward, we would like to further investigate how the COVID-19 pandemic may have further exacerbated pediatric health disparities by analyzing health outcomes based on patients' preferred language (English or other) and home zip code and corresponding census info (median household income, percent living below the poverty line). In our at-risk population, based on the above data, we propose implementing proactive counseling by primary care providers (PCP) on safety around FBI. Education provided to families at PCP visits on securing dangerous objects in the home may help decrease FBI especially during times when children are required to be at home more often, like during a pandemic.