Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline

Abstract

AimTo evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance.MethodsIn May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X‐ray requests between January 2016 and March 2022. Management was compared to national guidance.ResultsThere were 138 patient episodes of magnet ingestion, with a rising incidence over the 5‐year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow‐up X‐ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance.ConclusionManagement of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.

Gastroscopy is not always mandatory in all gastric multiple magnet ingestion cases

“…The paper by McLeish et al 1 . demonstrated the effectiveness of a Royal College of Emergency Medicine Best Practice Guideline for managing the accidental ingestion of magnets.…”

“…It should be evident when a significant number of magnets are moving in the stomach and a fluoroscopic examination can verify this. Having said that, we agree that early endoscopic treatment should be the primary course of action, in line with guidelines, and McLeish et al's 1 recommendations, for multiple magnets. If fluoroscopy is not available, endoscopic intervention should be used to remove the magnets.…”