6231 A practical goal to reduce ionizing radiation exposure in children presenting with metallic non-hazardous foreign body ingestion

Objectives There is evidence of high sensitivity of hand-held metal detectors (HHMD) in detecting the location of swallowed metallic non-hazardous foreign bodies. However, it's use is not yet universal in children's emergency departments in the United Kingdom. We aimed to evaluate the management of metallic non-hazardous foreign body ingestion, and identify those who can be safely managed solely with HHMD in a district general hospital emergency department (ED). Methods Retrospective and prospective electronic records review was performed from 1 September 2022 and 30 September 2023 for children with confirmed history of metallic foreign body ingestions. Suspected or confirmed history of button battery, magnets, sharp objects, and unclear history were excluded. Results We analysed 60 attendances of 55 children who presented with metallic non-hazardous foreign body ingestion. There was male preponderance in the ratio of 1.6:1. Forty seven percent (26/55) of children were of school age. Sixty seven percent (37/55) of ingested foreign bodies were coins. Foreign body demonstration (chest and abdomen) radiographs were performed in 86.7% (52/60) of attendances. The 5 reattendances had repeat radiographs following varied clinician advice. Whilst 57.7% (30/52) of radiographs performed demonstrated foreign bodies in the abdomen, no foreign body was visualised in 30.7% (16/52). All foreign bodies located in abdomen required no intervention. Five of the 6 patients with foreign bodies in the oesophagus were symptomatic on presentation. Two patients had endoscopic removal by the local ENT team, whilst the other 3 were transferred to tertiary centres. Conclusion The use of HHMD could have avoided ionising radiation exposure in nearly 90% of children. A guideline on the use of HHMD has been produced with safety netting advice for parents and carers for consistency of information. There is ongoing training on the use of HHMD for nursing staff and clinicians in our ED. A prospective service evaluation is underway.