P1455 - Foreign Body Ingestion: A Hard Pill to Swallow

Award: Outstanding Research Award in the General Endoscopy Category (Trainee)
Award: Presidential Poster Award

Award: Outstanding Research Award in the General Endoscopy Category (Trainee)

Award: Presidential Poster Award

Philip J. Riddle, MD¹, Hata Mujadzic, MD¹, Shayan Noorani, DO², Heather Peluso, DO³, Marwan Abougergi, MD^4
1University of South Carolina School of Medicine, Columbia, SC; ²Prisma Health-University of South Carolina School of Medicine, Columbia, SC; ³Prisma Health Upstate, Simpsonville, SC; ⁴University of South Carolina, Columbia, SC

Introduction: Foreign body ingestions can be accidental or intentional. We sought to quantify the extent of this problem at the national level, along with the associated morbidity, mortality and healthcare expenditure.

Methods: This is a retrospective cohort study using the 2018 National Emergency Department Sample (NEDS). The inclusion criterion was a principal diagnosis of foreign body ingestion. Exclusion criteria were age less than 18 years. The primary outcome was the annual number of Emergency Department (ED) visits. The secondary outcomes were: 1) patient demographics including psychiatric diagnoses, 2) hospital admission rate, 3) mortality rate, 4) procedures performed, and 5) financial burden on the healthcare system. Means were compared using the student’s t-test and proportions using Pearson’s Chi Square test.

Results: There were 165,175 ED visits for foreign bodies in 2018 in the United States, which was comparable to the number of ED visits for ST elevation myocardial infarction (STEMI) in the same year (177,254). Of all foreign bodies, 128,498 (78%) were ingested, with 40.8% found in the esophagus or stomach. The mean patient age was 19.8 (95% CI [18.8-20.8]) years and 56% were males. Most patients (84%) were discharged from the ED. Psychiatric comorbidity was 8 fold higher among patients who were admitted compared with those who were not (45.8% versus 5.1%, p< 0.01). The number of procedures was lower in the hospital than in the ED. However, more invasive and morbid procedures (laparotomy, endoscopy) were performed in the hospital. Mortality, although low, occurred only after admission (0% in ED versus 0.24% in the hospital, p=0.02). The mean length of stay was 4.5 (95% CI [3.8, 5.2]) days. The mean total hospitalization charges were 13 fold higher among admitted patients compared with those who were not ($44,704 versus $3,439, p< 0.01), resulting in a cumulative healthcare financial burden of $772 million (ED: $392 million, hospital: $380 million).

Discussion: ED visits for foreign bodies are as common as those for STEMI. The majority of foreign bodies are ingested and found in the esophagus or stomach. Psychiatric comorbidity is highly associated with hospital admission, surgical procedures, mortality and substantially higher healthcare utilization. Thus, mental health treatment is a high-yield target for decreasing mortality, morbidity, and more than half the healthcare financial burden in this setting.

Table: Table 1. Patient Outcomes


Disclosures:
Philip Riddle indicated no relevant financial relationships.
Hata Mujadzic indicated no relevant financial relationships.
Shayan Noorani indicated no relevant financial relationships.
Heather Peluso indicated no relevant financial relationships.
Marwan Abougergi indicated no relevant financial relationships.


Philip J. Riddle, MD¹, Hata Mujadzic, MD¹, Shayan Noorani, DO², Heather Peluso, DO³, Marwan Abougergi, MD⁴. P1455 - Foreign Body Ingestion: A Hard Pill to Swallow, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.