Esophageal Button Battery Management Clinical Pathway

Pathway Background and Objectives

In the US, approximately 3,500 children are treated annually in emergency departments for button battery ingestion. Button batteries that are lodged in the esophagus have the potential to cause catastrophic thermal injuries. Quick recognition and removal of the battery leads to improved prognosis. Progression of injury, however, can lead to death within six hours of ingestion in some cases. Ideally, batteries should be removed within two hours of ingestion. The specific objectives of this algorithm are to:

Standardize care to decrease variation in the management of patients with ingestion of esophageal button batteries
Decrease time to operative removal in order to improve clinical outcomes for patients with button battery ingestions
Decrease unnecessary interventions and testing
Clearly delineate safe discharge criteria

Algorithm Educational Module

Key References

Anfang RR, et al. pH-neutralizing esophageal irrigations as a novel mitigation strategy for button battery injury. Laryngoscope. 2019 Jan;129(1):49-57.
National Capital Poison Center Button Battery Ingestion Triage and Treatment Guideline. June 2018.
Ing RJ, Hoagland M, Mayes L, Twite M. The anesthetic management of button battery ingestion in children. Can J Anaesth. 2018 Mar;65(3):309-318.
Jatana KR, Rhoades K, Milkovich S, Jacobs IN. Basic mechanism of button battery ingestion injuries and novel mitigation strategies after diagnosis and removal. Laryngoscope. 2017 Jun;127(6):1276-1282.
Litovitz T, Whitaker N, Clark L, White NC, Marsolek M. Emerging battery-ingestion hazard: clinical implications. Pediatrics. 2010 Jun;125(6):1186-1177.
Leinward K, Brumbaugh DE, Kramer RE. Button battery ingestion in children: a paradigm for management of severe pediatric foreign body ingestions. Gastrointest Endosc Clin N Am. 2016 Jan;26(1):99-118.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.