A retrospective cohort study on clinical features of foreign bodies in the gastrointestinal tract of children-emergency data from a pediatric regional medical center in eastern China.

Background: Gastrointestinal foreign bodies (GIFB) in children are one of the most common non-traumatic emergencies in pediatric emergency departments, showing an upward trend year by year in China. If processing is delayed, it can lead to catastrophic consequences. This study aims to clarify the epidemiological characteristics of GIFB in a certain area of eastern China and the independent risk factors for its complications, providing evidence-based thresholds and warning indicators for the regional emergency collaborative network. This retrospective cohort study aimed to (I) describe the epidemiological characteristics of GIFB in children presenting to a regional pediatric medical center in eastern China from October 2021 to October 2024; and (II) identify independent risk factors for complications. Methods: We included all children aged 0-18 years with confirmed GIFB admitted through the Emergency Department of Children's Hospital, Zhejiang University School of Medicine. Data were extracted from electronic medical records. Complications were defined as gastrointestinal ulceration, perforation, esophagitis, gastritis, bleeding, obstruction, or mediastinitis. Multivariate logistic regression was used to identify independent risk factors, adding an interaction term between age group and ingestion method, adjusting for age, gender, foreign body type, number, retention location, retention time, ingestion method, and mental disorder comorbidity. Results: A total of 726 pediatric patients were included in this study. The age ranged from 3 months to 14 years, with an average age of (33.6±25.2) months. There were 428 male cases (59%) and 298 female cases (41%). The most common type of foreign matter was coins (63.2%, 459/726); the primary retention sites were the intestine (53.0%, 386/726) and the upper esophagus (42.0%, 305/726). The average retention time was (14.2±9.6) hours. Complications occurred in 152 cases (20.9%, 152/726), mainly including ulcers, perforations, and esophagitis. The primary intervention was esophagogastroduodenoscopy (EGD) removal (72.3%, 525/726), and (26.4%, 192/726) of foreign bodies were spontaneously expelled via conservative treatment; 9 cases (1.3%, 9/726) required surgical intervention. Multivariate regression analysis showed that younger age, longer retention time, upper esophageal retention, intentional swallowing, and comorbid mental illness, and the interaction between age <4 years and intentional swallowing are risk factors for the development of complications (P<0.05). Conclusions: Foreign bodies in the digestive tract of children are most commonly found in young toddlers, with a high incidence of complications. Factors contributing to complications include younger age (<4 years), upper esophageal location, intentional ingestion, and coexisting mental illness. Shorter retention time (≤24 hours) was associated with lower complication risk. Early identification and intervention have a significant impact on the outcome for these children.