Magnitude and object-specific hazards of aspiration and ingestion injuries among children in Greece

Objective: To assess the public health impact of injuries due to foreign body aspirations and ingestions among children in terms of overall magnitude and estimation of object-specific incidence. Methodology: Two thousand two hundred and seven injuries due to aspiration and ingestion of foreign bodies were identified among 110 066 records of children (less than 15 years old) collected by the Hellenic Emergency Department Injury Surveillance System (EDISS) during the 5-year study period 1996-2000. Countrywide estimates of overall and object-specific injury incidence rates were computed using appropriate age and place of residence-sampling ratios. Simple cross-tabulations were performed along with a free text description analysis of injury events, whereas a composite score using (1) frequency of injury occurrence, (2) hospitalisation rate and (3) average length of hospitalisation was developed to measure the overall object-specific burden of injuries. Results: Aspirations and ingestions of foreign bodies accounted for 2% of the total burden of accident and emergency department visits, corresponding to an annual incidence of approximately 2.3 accidents per 1000 children. Fish bones and nuts prevailed among the high (44%) proportion of aspirations and ingestions due to edible foreign bodies, while the main inedibles involved were small objects. Toddlers, boys and migrant children were over-represented among children sustaining injuries due to inedibles. As expected, the vast majority of food-related injuries occurred in the kitchen, in most instances under parental supervision. Injuries due to edibles were of minor severity and treatment was provided in the emergency departments, while those due to inedibles were responsible for injuries resulting in higher hospitalisation rates, albeit of relatively short duration. The composite impact score was highest for nuts and other food, nails, pins and sharp instruments. X-rays were performed in nearly all cases; upper gastrointestinal endoscopy was required in about 1 out of 10 instances and laryngoscopy or bronchoscopy in 1 out of 20, whereas the object was spontaneously removed in less than 3% of the cases. Conclusions: Depending on whether caused by edible or inedible objects, injuries due to foreign body aspirations and ingestions showed distinct epidemiological patterns. Composite scores taking into account measures of injury frequency and severity, seemed to reflect a country-specific spectrum of this type of injuries and provided useful information for the design of targeted public health oriented interventions.