Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019

doi:10.1016/j.jpeds.2021.01.052

The Journal of Pediatrics

Volume 232, May 2021, Pages 251-256.e2

https://doi.org/10.1016/j.jpeds.2021.01.052 Get rights and content

Objective

To examine, using the National Poison Data System (the data warehouse for poison control centers in the US), magnet foreign body injuries in pediatric patients. We sought to report demographic data, outcome data, and case trends between 2008 and 2019.

Study design

We conducted a retrospective analysis of the National Poison Data System for patients younger than 19 years of age with a magnet “exposure,” which poison centers define as an ingestion, inhalation, injection, or dermal exposure to a poison.

Results

A total of 5738 magnet exposures were identified. Most were male (3169; 55%), <6 years old (3572; 62%), with an unintentional injury (4828; 84%). There were 222 patients (3.9%) with a confirmed medical “effect,” defined as signs, symptoms, and clinical findings not including therapeutic interventions (eg, endoscopy). There was a 33% decrease in cases from 418 (2008-2011) to 281 per year (2012-2017) after high-powered magnet sets were removed from the market. Calls subsequently increased 444% to 1249 per year (2018-2019) after high-powered magnet sets re-entered the market. Cases from 2018 and 2019 increased across all age groups and account for 39% of magnet cases since 2008.

Conclusions

Significant increases in magnet injuries correspond to time periods in which high-powered magnet sets were sold, including a 444% increase since 2018. These results reflect the increased need for preventative or legislative efforts.

Section snippets

Methods

The AAPCC is a consortium of 55 poison control centers (PCCs) from all 50 states and US territories.³⁰ The network of regional PCCs in the US offer free, confidential medical advice 24 hours per day by telephone through the Poison Help Line. During case management, measures such as exposure, age, sex, substance, clinical effects, therapies, and medical outcomes are documented by the healthcare professional answering each call. Information gathered from these calls, and follow ups, are uploaded

Results

A total of 5738 pediatric magnet exposures were reported to US PCCs between 2008 and 2019, with 39% of cases occurring between 2018 and 2019. The mean age was 5.2 years (SD = 4.1), ranging from 5 months to 19 years old. The majority were male (55.2%) and <6 years old (62.3%) (Table I). Approximately one-half (48.4%) of patients were treated at a hospital or other healthcare facility, such as a pediatrician's office, and 48.7% were managed at a non-healthcare site such as home, workplace, or

Discussion

The data demonstrate a statistically significant change in cases of magnet exposure that correlates to magnet availability. In 2012, the US CPSC halted the sale of high-powered magnet sets and instituted a recall. In 2014, the CPSC finalized a federal rule (16 CFR Part 1240) limiting the strength and/or size of magnets sold as part of a set.²⁴ These actions effectively eliminated the sale of high-powered magnets from the market. Following the removal of high-powered magnet sets by the CPSC in

References (37)

M. Strickland et al.
Magnetic foreign body injuries: a large pediatric hospital experience
J Pediatr
(2014)
J.C. Brown et al.
Pediatric magnet ingestions: the dark side of the force
Am J Surg
(2014)
E. Blevrakis et al.
Multiple magnet ingestion causing instestinal obstruction and entero-enteric fistula: which imaging modality besides radiographs? A case report
Ann Med Surg (Lond)
(2018)
S. Merchant et al.
Intragastric fistula after multiple sphere magnet ingestion
Clin Gastroenterol Hepatol
(2017)
M. Olczak et al.
A case of child death caused by intestinal volvulus following magnetic toy ingestion
Leg Med (Tokyo)
(2015)
D. Rosenfield et al.
After the recall: reexamining multiple magnet ingestion at a large pediatric hospital
J Pediatr
(2017)
E.M. Caravati et al.
Use of clinical toxicology resources by emergency physicians and its impact on poison control centers
Ann Emerg Med
(1991)
P.M. Wax et al.
The arrival of the ED-based POISINDEX: perceived impact on poison control center use
Am J Emerg Med
(1994)
M.M. Tavarez et al.
Prevalence, clinical features and management of pediatric magnetic foreign body ingestions
J Emerg Med
(2013)
D.D. Gummin et al.
2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report
Clin Toxicol (Phila)
(2019)

R.E. Kramer et al.

Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee

J Pediatr Gastroenterol Nutr

(2015)

Zen Magnets

S. McCormick et al.

Children and mini-magnets: an almost fatal attraction

Emerg Med J

(2002)

Gastrointestinal injuries from magnet ingestion in children—United States, 2003-2006

MMWR Morb Mortal Wkly Rep

(2006)

S. Arslan et al.

Jejunoileal perforation and volvulus caused by multiple magnet ingestion

Acta Clin Croat

(2015)

S. Castaneda Espinosa et al.

Magnet intestinal lesions. Case series

Cir Pediatr

(2013)

J. Cho et al.

Magnetic foreign body ingestion in pediatric patients: report of three cases

BMC Surg

(2017)

A.C. De Roo et al.

Rare-earth magnet ingestion–related injuries among children, 2000-2012

Clin Pediatr

(2013)

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To assess the clinical complications reported after the ingestion of magnetic foreign bodies (FBs) in pediatric age, along with their incidence among all FB ingestions and clinical presentation.
We've consecutively recruited all children aged 0–14 years who were admitted for single or multiple magnet ingestion from May 2015 to December 2022. Patient demographics, admission sources and discharge status were accurately recorded, along with their clinical management and outcomes.
Sixty-one children were enrolled, of whom 49/61 (80.3%) had ingested a single magnet and 12/61 (19.7%) multiple magnets. Only 1/49 children with single magnet required endoscopic removal due to esophageal retention. Among children having ingested multiple magnets, 5/12 (41.7%) undergo endoscopic removal since magnets were amenable to endoscopic retrieval whereas in 7/12 (58.3%) magnets could not be promptly removed. Among these, 4/12 (33.3%) later developed intestinal ischemia/necrosis or perforation and required FB surgical intervention whereas 3/12 (25%) uneventfully evacuated magnets.
Our data confirm that multiple magnet ingestion, unlike single magnet ingestion, pose a serious health hazard. Parents and caregivers should remove them from the reach of children. Medical providers should maintain a high index of suspicion of their ingestion since prompt evaluation and likely removal may be lifesaving and intestine saving.
Multicentre study of magnet ingestion in Spanish paediatric emergency departments
2022, Anales de Pediatria
Las ingestas de objetos imantados pueden presentar complicaciones en el niño, no existiendo datos epidemiológicos ni clínicos en España.
Conocer la incidencia de ingesta de objetos imantados en los servicios de urgencias pediátricos españoles, sus características epidemiológicas y su manejo.
Estudio observacional prospectivo multicéntrico realizado durante 3 años. Población de referencia menores de 14 años.
La incidencia fue de 4,8/100.000 urgencias. De los 72 pacientes incluidos (edad media de 7,2 años), el 54% fueron varones. El 7% presentaron antecedentes neuropsiquiátricos. El 61% de los imanes fueron esféricos y el 69% procedían de juguetes. El tamaño fue variable con un predominio de los imanes entre 5 y 10 mm (50%). El 86% fueron asintomáticos. El síntoma más frecuente fue el dolor abdominal. El 83% de los pacientes consultaron en menos de 6 h y el 92% en las primeras 24 h. El 31% fueron ingestas múltiples. El 15% precisó intervención endoscópica, cifra que ascendió al 36% en los casos de ingestas múltiples. No se realizó ninguna intervención quirúrgica. No se observó ninguna complicación gastrointestinal secundaria.
Las ingestas de imanes múltiples son menos frecuentes que las simples y en este estudio no se han observado complicaciones a pesar de que las intervenciones realizadas han sido menores que en otros estudios.
The ingestion of magnetic objects can cause complications in children, and there are no epidemiological or clinical data on the subject in Spain.
To determine the incidence, epidemiological characteristics and management of magnet ingestion in paediatric emergency departments in Spain.
Prospective observational multicentre study conducted over a 3-year period. The study universe consisted of patients aged less than 14 years.
The incidence was 4.8 cases per 100 000 emergency care episodes. Of the 72 patients included (mean age, 7.2 years), 54% were male. Seven percent had neuropsychiatric disorders. Sixty-one percent of the magnets were spherical and 69% came from toys. The size was variable, most frequently between 5 and 10 mm (50%), and ranging from 3 to 30 mm. Eighty-six percent of patients were asymptomatic. The most frequent symptom was abdominal pain. Eighty-three percent of the patients sought medical care within 6 h of ingestion and 92% within 24 h. Thirty-one percent of the cases were of multiple ingestion. Endoscopy was required for extraction in 15% of cases, a proportion that rose to 36% in the group of cases of multiple ingestion. None of the patients required surgery. We did not observe any gastrointestinal complications of magnet ingestion.
The ingestion of multiple magnets is less frequent than single magnet ingestion, and we did not observe any complications despite the lower frequency of procedures compared to other studies.
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View all citing articles on Scopus

: The authors declare no conflicts.

^∗: Contributed equally.

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Original ArticleMagnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019

Objective

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Am J Surg

Ann Med Surg (Lond)

Clin Gastroenterol Hepatol

Leg Med (Tokyo)

J Pediatr

Ann Emerg Med

Am J Emerg Med

J Emerg Med

2018 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 36th Annual Report

Clin Toxicol (Phila)

Management of ingested foreign bodies in children: a clinical report of the NASPGHAN Endoscopy Committee

J Pediatr Gastroenterol Nutr

Zen Magnets

Children and mini-magnets: an almost fatal attraction

Emerg Med J

Gastrointestinal injuries from magnet ingestion in children—United States, 2003-2006

MMWR Morb Mortal Wkly Rep

Jejunoileal perforation and volvulus caused by multiple magnet ingestion

Acta Clin Croat

Magnet intestinal lesions. Case series

Cir Pediatr

Magnetic foreign body ingestion in pediatric patients: report of three cases

BMC Surg

Rare-earth magnet ingestion–related injuries among children, 2000-2012

Clin Pediatr

Original Article
Magnet Injuries in Children: An Analysis of the National Poison Data System from 2008 to 2019