Don’t forget the LEGO

Everything is Awesome: Don’t Forget the LEGO

Tagg A. Journal of Paediatrics and Child Health 2018; doi:10.1111/jpc.14309

Clinical Question

  • In adult subjects who ingest a small toy part, compared to historical controls of children who have ingested coins, is there a difference in object transit time and complication rate?

Background

  • Children in their developmental years will explore their environments, often by ingesting objects with no nutritional value
  • The most commonly ingested object (coins) has been shown to pass safely within 3-5 days with no ill effects (Spitz et al 1971)
  • There is a paucity of data regarding the second most commonly swallowed object – “toy parts”
  • The lead author wanted to get a study into the Christmas BMJ

Design

  • Prospective, observational, non-blinded cohort study
  • Standardised toy part of uniform dimensions (Lego Head) used
  • Foreign object ingested at the same time of day (0700-0900)
  • Bowel habit standardised between participants through the use of the Stool Hardness And Transit (SHAT score) – an average of Bristol Stool Chart scales over 3 days; with higher score indicating looser motions
  • SHAT score compared pre ingestion  (pre SHAT) and post ingestion ( SHAT)

Setting

  • 5 centres -3 in UK, 2 in Australia
  • Unspecified 2 week period in 2018

Population

  • Inclusion: Healthcare professionals working within paediatric hospital care
  • Exclusion:
    • previous gastrointestinal surgery
    • inability to ingest foreign objects
    • An aversion to searching through faecal matter 
  • 6 adult patients
  • 50% male
  • Mean age 36.2 (27-45)

Intervention

  • Ingestion of standard Lego mini figure head

Control

  • Historical controls from previous studies of ingested coins (Spitz, 1971)

Outcome

  • Primary outcome: The Found and Retrieval Time (FART) score
    • 5/6 figures retrieved
    • Mean bowel motions to retrieval =2 (range 1-3)
    • Average FART score 1.71 days (1.14 to 3.04 days)
    • One participant searched 13 stools unsuccessfully over a 2 week period, with this figure yet to be located
  • Secondary outcome: Comparison of SHAT and FART scores
    • Pre study SHAT score (n=6) range 3 o 5.67
    • Post study SHAT score (n=5) range 2.96 to 7.76
    • No significant difference noted between pre and post study SHAT scores
    • No correlation noted between SHAT and FART scores

Authors’ Conclusions

  • Small objects, such as those followed by children, are likely to pass between 1 and 3 days without complication

Strengths

  • Important research question
  • Standardisation of toy object and stool scoring
  • Male-female balance
  • The courage and determination of the authors must be lauded; many researchers lack the constitution to undergo such self-experimentation

Weaknesses

  • Non-randomised
  • Non-blinded
  • Small numbers- the true complication rate cannot be estimated from this study
  • An adult population was studied, which is different from the population of interest (children)
  • The authors SHAT themselves- this would have covered them in difficult to remove bias
  • Search technique and searcher not standardised- exemplified by one item not being found
  • Unvalidated scoring methods used in the study- the SHAT score is arguably crap and the FART score is arguably a load of hot air
  • One head was lost to follow up (follow through?) – the authors should have tried/pushed harder to locate it

The Bottom Line

  • In this trial of 6 adults ingesting a standard Lego head, 5 of them were found within 3 days
  • This adds to years of data and human experience before that have already confirmed that swallowing small objects are safe for the vast majority of large and small humans
  • I will not feel strained by human ingestion of small objects, and will feel under no pressure to furrow through faeces to find them

External Links

Metadata

Summary author: Segun Olusanya
Summary date: 23rd December 2018
Peer-review editor: Adrian Wong

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