Facility type as the primary determinant of hospitalization in pediatric foreign body ingestion: a nationwide emergency department-based analysis

Purpose:We aimed to characterize pediatric emergency department (ED) visits for foreign body (FB) ingestion in Korea, and to identify clinical-and system-level determinants of hospitalization. Methods:We analyzed 2,870 children aged 9 years or younger who visited EDs with FB ingestion from 2019 through 2023, using the National Emergency Department Information System.Emergency facilities were classified into regional emergency medical centers (EMCs), local EMCs, and local emergency medical facilities (EMFs), in descending order of hierarchy.Regression models sequentially incorporated clinical variables and the facility type to identify hospitalization determinants.Mediation analysis quantified the role of the facility type in regional disparities.Results: Most visits involved ages of 1-4 years (55.3%) and were a Korean Triage and Acuity Scale 4-5 (76.0%), with an 8.1% overall hospitalization rate.The visits were concentrated in the capital region (i.e., Seoul, Incheon, or Gyeonggi Province), with Seoul highest (168.1 per 100,000 children).Compared with the regions, non-capital regions showed higher percentages of Korean Triage and Acuity Scale 1-3 (21.6% vs. 24.4%)and visits to local EMFs (3.9% vs. 28.6%),yet showed a lower hospitalization rate (6.7% vs. 8.9%).In a regression model, the facility type was the strongest determinant of hospitalization (compared with local EMFs: regional EMCs, adjusted odds ratio = 14.20 [95% confidence interval,).The effect of the capital region was attenuated after adjusting for the facility type (adjusted odds ratio, from 1.76 to 1.45).Mediation analysis suggested an association of the regional disparities with the unequal distribution of EMCs. Conclusion:In pediatric FB ingestion, hospitalization is driven by regional disparities in facility access, with facility type acting as a mediator.The paradoxical lower hospitalization rate in the noncapital regions may reflect differential facility access, highlighting the need for a tiered regional strategy.