A new study from Rhode Island Hospital found that 33 individuals were responsible for 305 cases of medical intervention to remove foreign bodies that were intentionally swallowed, resulting in more than $2 million in estimated hospital costs. The findings appear in the November issue of Clinical Gastroenterology and Hepatology.
Through a retrospective case study over an 8-year period, the researchers identified 305 cases of the intentional ingestion of foreign bodies at Rhode Island Hospital, a Level I trauma center in Providence, RI. The most common items were pens (24 percent), batteries (9 percent), knives (7 percent) and razor blades (7 percent). For the most part, extraction of the foreign bodies was successful during the initial endoscopic extraction except for 20 cases, and only two cases eventually required a surgical extraction. The 305 cases were associated with 33 patients, of which 79 percent were previously diagnosed with a psychiatric disorder.
Steven Moss, MD, is a gastroenterologist at Rhode Island Hospital and lead author of the paper. Moss says, "Intentional foreign body ingestion occurs among a relatively small number of patients with psychiatric disorders and is costly. While endoscopic retrieval is relatively safe and effective, it often requires general anesthesia and utilizes significant hospitals resources."
In 237 of the cases, the foreign bodies were successfully retrieved, most commonly from the stomach or esophagus. Attempts at removal were not successful in only 10 cases and surgical consults were required for these patients. There were no cases of perforations or patient deaths. Hospital costs incurred in the patients' care from these 305 cases totaled $2,018,073, borne primarily by government payers (Medicare and Medicaid). The greatest contributors to the costs were nursing care (56 percent), followed by endoscopy, emergency department and surgical services.
Moss states, "Our study shows that intentional ingestion of foreign bodies is a relatively common event at our hospital. Intentional, rather than accidental, swallowing is a poorly recognized and underappreciated problem which is potentially avoidable. A small number of patients, many of whom suffer from co-morbid psychiatric diagnoses, were responsible for over 300 foreign body swallowing cases, and more than two million dollars in hospital and physician costs." He adds, "Endoscopy was very safe and highly successful in retrieving the swallowed objects, and minor complications occurred in only 11 cases."
Moss reports that 58 percent of the patients were male while 42 percent were female and the mean age for the patients at the time of ingestion was 35. One patient was solely responsible for 67 of the 305 cases, while four patients accounted for 179 cases. More than half of the patients (53 percent) were admitted from residential institutions, mostly from a state-run chronic psychiatric inpatient facility. Thirty-eight percent of the patients were from private homes in the community, while nine percent were from prison. More than half of the patients were diagnosed with a mood disorder, while others suffered from anxiety, substance abuse, psychotic or impulse control disorders.
Co-author Colin Harrington, MD, a psychiatrist in the department of psychiatry at Rhode Island Hospital, explains, "The reasons for foreign body ingestion vary and it is one of many forms of self-injurious behavior. Foreign body ingestion can be a behavioral element of cognitive disorders, mental retardation syndromes, psychotic disorders, and mood disorders. Various personality disorder diagnoses are also associated with foreign body ingestion where motivations are thought to include communication of internal distress, acting out due to anger, or even manipulation of the environment with a related secondary gain, such as transfer out of chronic institutional settings like prison or long-term treatment facilities." He adds, "In most cases foreign body ingestion does not represent a frank suicide attempt. Repetitive foreign body ingestion occurs in a very small group of patients and is typically difficult to treat and prevent."
Moss and the researchers conclude, "Foreign body ingestion is poorly understood, difficult to treat, and consumes considerable physician time and hospital resources. Attention should be focused on investigating how to avoid these preventable and costly episodes."
Moss and Harrington are both members of the faculty at The Warren Alpert Medical School of Brown University. Moss is also a physician with University Medicine (www.umfmed.org), a non-profit, multi-specialty medical group practice employing many of the full-time faculty of the department of medicine of the Alpert Medical School.
Other researchers involved in the study with Moss and Harrington are Brian Huang, MD; Harlan Rich, MD; Susan Simundson, MHA; Mukesh Dhingana, MA, MBA; all of Rhode Island Hospital and Alpert Medical School.
Rhode Island Hospital (www.rhodeislandhospital.org), founded in 1863, in Providence, RI, is a private, not-for-profit hospital and is the principal teaching hospital of The Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. The hospital receives nearly $50 million each year in external research funding and is home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care. It is a founding member of the Lifespan health system.
Nancy Cawley Jean | EurekAlert!
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
28.04.2017 | Event News
20.04.2017 | Event News
18.04.2017 | Event News
28.04.2017 | Medical Engineering
28.04.2017 | Earth Sciences
28.04.2017 | Life Sciences