Name: handheld metal detector screening for metallic foreign body ingestion in children
Uploaded: 2018-09-11T15:00:00
Description: Watch this Scientific Journal Video about Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children at JoVE.com

The authors thank Dr. Lee Khai Pin, Head &#38; Senior Consultant, Children&#39;s Emergency, KK Women&#39;s and Children&#39;s Hospital, 100 Bukit Timah Road, Singapore for the administrative support with the video article production.&#160;Article reproduced with permission from &#8220;Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency&#8221;; August 2018: 85(8):618&#8211;624; Hazwani Binte Hamzah, Vigil James, Suraj Manickam, Sashikumar Ganapathy: copyright The Indian Journal of Pediatrics.

The protocol follows the guidelines of Institutional Human Research Ethics committee. The central institutional review board provided the ethics approval for the study.
1. Participant Screening
<ol>
	<li>Recruit patients who present to the pediatric emergency department with history of foreign body ingestion.</li>
	<li>Exclude the patients who are in respiratory distress and has implanted devices like pace makers.</li>
</ol>
2. Prepare the Patient
<ol>
	<li>Dress th...

<ol>
	<li>Lee, J., Ahmad, S., Gale, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Detection+of+coins+ingested+by+children+using+a+handheld+metal+detector:+a+systematic+review.">Detection of coins ingested by children using a handheld metal detector: a systematic review.</a> Emergency Medicine Journal. 22 (12), 839-844 (2005).</li><li>Hesham A-Kader, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foreign+body+ingestion:+children+like+to+put+objects+in+their+mouth.">Foreign body ingestion: children like to put objects in their mouth.</a> World Journal of Pediatrics. 6 (4), 301-310 (2010).</li><li>Muensterer, O. 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R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+metal+detector+to+identify+ingested+metallic+foreign+bodies.">Use of a metal detector to identify ingested metallic foreign bodies.</a> American Journal of Roentgenology. 155 (4), 803-804 (1990).</li><li>Younger, R. M., Darrow, D. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+metal+detector+confirmation+of+radiopaque+foreign+bodies+in+the+esophagus.">Handheld metal detector confirmation of radiopaque foreign bodies in the esophagus.</a> Archives of Otolaryngology--Head &amp; Neck Surgery. 127 (11), 1371-1374 (2001).</li><li>Schalamon, J., Haxhija, E. Q., Ainoedhofer, H., G&#246;ssler, A., Schleef, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+a+hand-held+metal+detector+for+localisation+of+ingested+metallic+foreign+bodies+-+a+critical+investigation.">The use of a hand-held metal detector for localisation of ingested metallic foreign bodies - a critical investigation.</a> European Journal of Pediatrics. 163 (4-5), 257-259 (2004).</li><li>Kay, M., Wyllie, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+foreign+bodies+and+their+management.">Pediatric foreign bodies and their management.</a> Current Gastroenterology Reports. 7 (3), 212-218 (2005).</li><li>Rothmann, B. F., Boeckman, C. 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H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracheoesophageal+fistula+with+tracheal+stenosis+resulting+from+retained+esophageal+foreign+body.">Tracheoesophageal fistula with tracheal stenosis resulting from retained esophageal foreign body.</a> Auris Nasus Larynx. 38 (6), 753-756 (2011).</li><li>Dahiya, M., Denton, J. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Esophagoaortic+perforation+by+foreign+body+(coin)+causing+sudden+death+in+a+3-year-old+child.">Esophagoaortic perforation by foreign body (coin) causing sudden death in a 3-year-old child.</a> The American Journal of Forensic Medicine and Pathology. 20 (2), 184-188 (1999).</li><li>O'Brien, G. C., Winter, D. C., Kirwan, W. O., Redmond, H. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ingested+foreign+bodies+in+the+paediatric+patient.">Ingested foreign bodies in the paediatric patient.</a> Irish Journal of Medical Science. 170 (2), 100-102 (2001).</li><li>Bassett, K. E., Schunk, J. E., Logan, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Localizing+ingested+coins+with+a+metal+detector.">Localizing ingested coins with a metal detector.</a> The American Journal of Emergency Medicine. 17 (4), 338-341 (1999).</li><li>Gooden, E. A., Forte, V., Papsin, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+a+commercially+available+metal+detector+for+the+localization+of+metallic+foreign+body+ingestion+in+children.">Use of a commercially available metal detector for the localization of metallic foreign body ingestion in children.</a> The Journal of Otolaryngology. 29 (4), 218-220 (2000).</li><li>Sacchetti, A., Carraccio, C., Lichenstein, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hand-held+metal+detector+identification+of+ingested+foreign+bodies.">Hand-held metal detector identification of ingested foreign bodies.</a> Pediatric Emergency Care. 10 (4), 204-207 (1994).</li><li>Hamzah, H. B., James, V., Manickam, S., Ganapathy, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+Metal+Detector+for+Metallic+Foreign+Body+Ingestion+in+Pediatric+Emergency.">Handheld Metal Detector for Metallic Foreign Body Ingestion in Pediatric Emergency.</a> Indian Journal of Pediatrics. 85 (8), 618-624 (2018).</li><li>Doraiswamy, N. V., Baig, H., Hallam, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Metal+detector+and+swallowed+metal+foreign+bodies+in+children.">Metal detector and swallowed metal foreign bodies in children.</a> Journal of Accident &amp; Emergency Medicine. 16 (2), 123-125 (1999).</li><li>Seikel, K., Primm, P. A., Elizondo, B. J., Remley, K. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Handheld+metal+detector+localization+of+ingested+metallic+foreign+bodies:+accurate+in+any+hands.">Handheld metal detector localization of ingested metallic foreign bodies: accurate in any hands.</a> Archives of Pediatrics &amp; Adolescent Medicine. 153 (8), 853-857 (1999).</li><li>Lemberg, P. S., Darrow, D. H., Holinger, L. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Aerodigestive+tract+foreign+bodies+in+the+older+child+and+adolescent.">Aerodigestive tract foreign bodies in the older child and adolescent.</a> The Annals of Otology, Rhinology, and Laryngology. 105 (4), 267-271 (1996).</li><li>Stack, L. B., Munter, D. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Foreign+bodies+in+the+gastrointestinal+tract.">Foreign bodies in the gastrointestinal tract.</a> Emergency Medicine Clinics of North America. 14 (3), 493-521 (1996).</li><li>Saz, E. U., Arikan, C., Ozgen&#231;, F., Duyu, M., Ozananar, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+utility+of+handheld+metal+detector+in+confirming+metallic+foreign+body+ingestion+in+the+pediatric+emergency+department.">The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department.</a> The Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology. 21 (2), 135-139 (2010).</li></ol>

Metallic foreign body ingestion in children is a common problem and in the majority of patients, this is managed conservatively7,16. Single or repeated radiographs can expose the radio-sensitive pediatric population to unwanted radiation risk while attempting to localize the ingested metallic foreign body. Several studies have described the use of metal detectors in MFB ingestion in children, with sensitivity more than 96% and specificity greater than 80%<sup cla...

Foreign body ingestion is a widespread problem among children presenting to the pediatric emergency department because of the natural inquisitive nature of infants and children to explore objects by tasting and swallowing them1,2. Previous studies have reported that metallic objects constituted 85% of all foreign body ingestions in their cohort of patients3,4. The goal of this protocol is to assess the accuracy and feasibility of using a handheld metal detector to detect ingested metallic foreign bodies in children. We propose that by introducing the handheld metal detector screening protocol early in the triage process of children with high suspicion of metallic foreign body ingestion, the number of radiographs being ordered to localize the metallic foreign body can be reduced in this radio-sensitive population.
Handheld metal detector (HHMD) is an inexpensive, easily accessible adjunct that can help expedite the management of ingested metallic foreign bodies. Metal detector is a very low frequency device, which has a receiver and a transmitter that detects the change in its electromagnetic field caused by the presence of a metallic object in its vicinity3. If a metallic object is within the field, the electromagnetic field is disrupted and the sensor will set off an audio-visual alarm on the device4. The metal detector examination can be thoroughly performed in less than 2 minutes5. Hence, the HHMD screening can be introduced early in the triage process of children with high suspicion of metallic foreign body ingestion for topographical localization.
Coins are the most common swallowed metallic foreign bodies1,4,6,7. Due to the lack of sharp edges and general non-toxic nature, the majority of coin ingestions are managed conservatively. Other types of materials commonly ingested include magnets, button batteries, small toys, peanuts, jewelry, buttons, bones, seeds, and popcorn8,9. Impaction of foreign bodies most commonly occurs in the esophagus at three sites, namely upper esophageal sphincter, mid-esophagus at the level of aortic arch, and lower esophageal sphincter10. Metallic foreign bodies (MFBs) located in the esophagus may be asymptomatic in 40% of patients11,12 and its prolonged impaction can lead to various complications like esophageal perforation, mediastinitis, tracheoesophageal fistula, tracheal stenosis, and aorto-esophageal fistulas1,13,14,15. Other locations of foreign body impaction include pylorus, duodenum, and ileo-caecal junction10.
Performing radiographs of neck, chest, and abdomen to diagnose suspected foreign body ingestion is a widespread practice in the emergency departments5. Among all types of the ingested foreign bodies, only 10% are radio-opaque10. The radiological tests are time-consuming and have a risk of radiation exposure in children. Precise topographical localization of ingested metal objects is very crucial to guide therapy. The introduction of HHMD screening early in the triage process can help mitigate extraneous ordering of radiographs by topographically localizing the ingested metallic foreign body.
This study evaluated the accuracy of HHMD to localize MFBs in a systematic topographic fashion and determined the effectiveness and feasibility of HHMD in the local Pediatric population. We also examined how well this radiation free screening tool was accepted by the patients and parents. Between May and July 2016, all the consecutive patients who presented to the pediatric emergency department with a history of foreign body ingestion were included in the study. Informed consent was obtained from the parent or legal guardian. Patients with alleged foreign body ingestion were systematically scanned using HHMD. The gold standard of care for identification and localization of ingested metallic foreign bodies is performing plain radiographs of the cervical area, thorax, and abdomen. To facilitate the conduct of the study, a standardized workflow was created (Figure 1). A log book specifically created based on the workflow was used to collect the initial data, which were subsequently transcribed to a spreadsheet (Figure 2). The data in the result section are depicted as the number of cases followed by percentages.

<table>
	<tbody>
		<tr>
			<td>Hand held metal detector</td>
			<td>Garrett Super Scanner V</td>
			<td>NA</td>
			<td>NA</td>
		</tr>
	</tbody>
</table>

handheld metal detector screening for metallic foreign body ingestion in children

Coins are the most common ingested metallic foreign bodies among children. The goal of this protocol is to assess the accuracy and feasibility of using a handheld metal detector to detect ingested metallic foreign bodies in children. We propose that by introducing handheld metal detector screening early in the triage process of children with high suspicion of metallic foreign body ingestion, the number of radiographs being ordered to localize the metallic foreign body can be reduced in this radio-sensitive population. The study protocol requires the screening of the participants for history of foreign body ingestion and exclusion of patients with respiratory distress or metallic implants. The patient changes to hospital gown and items that could contain metal like eyeglasses, earrings, pendants, and ornaments are removed. The patient is positioned in the center of the room away from other metallic interferences. The working status of the handheld metal detector is first confirmed by eliciting a positive audio-visual signal. Then the screening is done in an erect position with head in extension to expose the neck, from the level of the chin to the level of the hip joint, to cover the anatomical areas from neck to pelvis in a zig-zag manner both anteriorly and posteriorly. A positive audio-visual signal is carefully noted during the scanning for the presence of metallic foreign body. Relevant radiographs are ordered as per the area detected on the metal detector screening. The handheld metal detector was able to precisely identify all the coins among the ingested metallic foreign bodies in our study. The handheld metal detector could not consistently detect non-coin metallic foreign bodies. This protocol demonstrates the accuracy of handheld metal detector in the identification and localization of coins and coin like metallic foreign bodies.

The researchers recruited 36 patients for this observational study. These patients had presented to the pediatric emergency department with a history of foreign body ingestion. Among these, 28 patients had metallic foreign body ingestions (Figure 3). The remaining 8 patients had ingested non-metallic foreign bodies such as fish bones, satay stick, and plastic button. Coins were the most common type of foreign body ingested (Table 1), which co...

Watch this Scientific Journal Video about Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children at JoVE.com

Handheld Metal Detector Screening for Metallic Foreign Body Ingestion in Children

Here, we present a protocol to use the handheld metal detector, to screen for the presence of ingested metallic foreign bodies in children who present to the pediatric emergency medicine department with a history of foreign body ingestion.

Coins are the most common ingested metallic foreign bodies among children. The goal of this protocol is to assess the accuracy and feasibility of using a ...

This method can help answer key questions in the field of pediatric emergency medicine, such as screening for metallic foreign body ingestion in children. The main advantage of this technique is that it is a very effective, rapid screening tool and it uses a radiation-free equipment. The implications of this technique extend to its early analysis of metallic foreign body ingestion in children by introducing handheld metal detector screening early in the child's process.The number of radiographs being ordered to locate the metallic foreign body can be reduced in this radio-sensitive population. Though this method can provide insight into early detection of ingested metallic foreign bodies in children during the initial emergency department visit, it can also be applied to follow up on the course and passage of ingested metallic foreign bodies. Generally, individuals new to this method might struggle because all of the relevant anatomical areas must be scanned thoroughly.Visual demonstration of this method is critical as patient preparation and systematic metal detector screening can be difficult steps to learn. Inadequate patient preparation can lead to false negative results. After screening the patient according to the text protocol, dress the patient in a hospital gown.After this, remove all items from the patient that may contain metallic objects. Ensure that the patient is moved away from all metallic objects to avoid interference with metal detector screening. Place the patient in the center of the room away from any potential metallic interference.After this, remove all metallic accessories such as jewelry or watches. Then, instruct the patient's caregiver to remove any of their metallic accessories. First, confirm the working status of the handheld metal detector, or HHMD.Then, instruct the patient to stand up for the exam and hold the patient's hands up and away from the body. Next, position the patient's head to extend and expose the neck. Start the scan from the chin and end the scan at the level of the hip joint.Perform the scan in a zigzag manner across the body to ensure that every area has been scanned. It is of paramount importance to scan all the relevant anatomical areas thoroughly, so that no potential areas are missed. Take the thickness of the patient into consideration and scan both anteriorly and posteriorly.During the scan, note any positive audiovisual signals from the HHMD. After performing the HHMD scan, order the relevant neck, chest, and abdominal radiographs. Next, correlate the positive HHMD signal with the underlying bony landmark on the body by palpating the sternal notch, xiphisternum, pubic symphysis, and the bilateral iliac crest.Finally, record the test results in the logbook. In this study, 36 pediatric patients were recruited when they presented to the emergency department with a history of foreign body ingestion. Of the 36 patients, 28 had metallic foreign body ingestions with coins being the most common type of foreign body ingested.The overall sensitivity and specificity of the HHMD to detect ingested metallic objects was 100%as validated by plain radiographs. While attempting this procedure, it is important to remember to move the patient away from all metallic objects to avoid interference with the metal detector screening and scan all the relevant anatomical areas thoroughly so that no potential areas are missed. Following this procedure, other methods, like x-ray examination, can be carried out to determine the specific anatomical location of the metallic foreign body.After it's development, this technique will allow researchers in the field of emergency medicine to explore alternative methods for repeat trial screening of metallic foreign body ingestion in pediatric patients.

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