Characterization of Accidental and Intentional Adult Foreign Body Ingestion in the United States

Intentional foreign body ingestion is a growing concern among adults, particularly those with social, psychiatric, and behavioral concerns, according to a study published in Gastrointestinal Endoscopy.

Foreign body ingestions are a common cause for medical attentions, yet its trends and patterns as well as association with clinical comorbidities and behavioral attributes have not been fully elucidated. Thus, this study assessed trends, demographics, and patient comorbidities for accidental and intentional foreign body ingestion in adults. Data came from the National Electronic Injury Surveillance System, which is a part of the Consumer Product Safety Commission that monitors emergency departments in the United States to estimate consumer product-related injuries. Records of cases from 2000 to 2017 were evaluated for diagnosis codes, substance abuse, mental illness, law-enforcement involvement, and category of foreign ingested body.

There were a total of 3903 cases included in this analysis, which when extrapolated to across the United States, would lead to an estimated 155,650 cases of foreign body ingestion over the course of the study. Over this time period, cases steadily increased, from 3 cases per 100,000 in 2000 to 5.3 cases per 100,000 in 2017 (P =.0002). Overall, there were 225 different categories of foreign bodies ingested with 15.40% being jewelry, 7.24% nails or tacks, 6.89% toothpicks, 5.30% drink container tabs, and 4.65% drinking glass fragments. The top 3 accidental foreign body ingestion included jewelry (10.3%), drinking glass fragments (7.9%), and nails or tacks (7.4%). The top 3 intentional foreign body ingestion included plastic bags (13.6%), batteries (13%), and nails or tacks (10.1%).

A review of case descriptions indicated 14% of adult ingestions were intentional, with risk factors of smuggling (body packing), substance abuse, mental illness, police custody, and intellectual disability. Regression analysis indicated that intentional foreign body ingestion had a higher odds ratio (OR) than accidental ingestion (OR 1.10; 95% CI, 1.02-1.19). Police custody (OR 71.16; 95% CI, 15.76-321.39), substance abuse (OR 20.53; 95% CI, 6.42-65.62), intellectual disability (OR 124.52; 95% CI, 48.38-320.46), and mental illness (OR 214.42; 95% CI, 66.32-693.23) were significantly associated with intentional foreign body ingestion when compared with accidental foreign body ingestion.

Limitations of this study include the potential for the dataset to have sampling and observer bias, the possibility for confounding variables not included in case descriptions, and the lack of psychiatric records and incarceration circumstances on the database.

The researchers concluded, “intentional [foreign body ingestions] associated with a distinctive pattern of ingested consumer products explain the growing incidence of [foreign body ingestions] over the past 2 decades.”

Reference

Hsieh A, Hsiehchen D, Layne S, Ginsberg GG, Keo T. Trends and clinical features of intentional and accidental adult foreign body ingestions in the United States, 2000 to 2017 [published online September 14, 2019]. Gastrointest Endosc. doi: 10.1016/j.gie.2019.09.010