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Trends and clinical features of intentional and accidental adult foreign body ingestions in the United States, 2000 to 2017

  • Author Footnotes
    ∗ Drs Hsieh and Hsiehchen contributed equally to this article.
    Antony Hsieh
    Correspondence
    Reprint requests: Antony Hsieh, Gastroenterology Fellow, or Thormika Keo, Clinical Assistant Professor in Medicine, Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, PCAM-South Pavilion, 7th Floor, 3400 Civic Center Blvd, Philadelphia, PA 19104-4311.
    Footnotes
    ∗ Drs Hsieh and Hsiehchen contributed equally to this article.
    Affiliations
    Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Author Footnotes
    ∗ Drs Hsieh and Hsiehchen contributed equally to this article.
    David Hsiehchen
    Footnotes
    ∗ Drs Hsieh and Hsiehchen contributed equally to this article.
    Affiliations
    Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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  • Sabrina Layne
    Affiliations
    Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Gregory G. Ginsberg
    Affiliations
    Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • Thormika Keo
    Affiliations
    Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Gastroenterology Section, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Drs Hsieh and Hsiehchen contributed equally to this article.
Published:September 14, 2019DOI:https://doi.org/10.1016/j.gie.2019.09.010

      Background and Aims

      Foreign body ingestions (FoBIs) are a common cause for medical attention. However, trends and patterns of adult FoBIs as well as associations with clinical comorbidities and behavioral attributes have not been elucidated beyond single institutional experiences.

      Methods

      We utilized survey data from the National Electronic Injury Surveillance System to examine fundamental characteristics of adult FoBIs involving consumer products between 2000 and 2017 across the United States. Data regarding the circumstances of FoBIs were abstracted from narrative data. Relationships among time, intent, demographics, and behavioral attributes were assessed using regression analyses, accounting for survey structure.

      Results

      Adult FoBIs have increased in incidence over the past 2 decades from 3 to 5.3 per 100,000 persons. Examination of consumer products revealed that jewelry (15.4%), nails (7.2%), and toothpicks (6.9%) were the most commonly ingested products. The most common products ingested varied over time, and the number of unique consumer product categories ingested increased from 103 to 143 in the time period studied. Intentional ingestions accounted for 14% of adult FoBIs and frequently involved plastic bagging (13.6%), batteries (13%), nails (10.1%), and desk supplies (6.8%). Adjusted regression analyses demonstrated that compared with accidental FoBIs, intentional FoBIs have increased over time. Intentional FoBIs were more frequently associated with younger age, substance abuse, police custody, and mental and cognitive illnesses relative to accidental FoBIs.

      Conclusions

      Our results indicate that adult FoBIs are an increasing burden of disease in the United States with social, psychiatric, and behavioral contributors to this trend.

      Abbreviations:

      CI (confidence interval), FoBI (foreign body ingestion), NEISS (National Electronic Injury Surveillance System), OR (odds ratio)
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      Linked Article

      • Consuming consumer products and the emergency department
        Gastrointestinal EndoscopyVol. 91Issue 2
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          Foreign body ingestion and food impactions are frequent consults from the emergency center. The treatment of these patients often requires planning, creative solutions, urgent evaluation, and endoscopic intervention. Although guidelines exist for both adult and pediatric populations, the quality of the literature is limited because most reports reflect single-center experiences with unclear generalizability to other settings.1-3 Data from a larger population reflecting the experience of multiple centers would help in clarifying the scope of the challenges these conditions present.
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