Retrospective Analysis of Pediatric Foreign Body Ingestion: A Decade of Emergency and Specialty Care at King Saud University Medical City (2013-2023).

BACKGROUND: Foreign body ingestion (FBI) is a common pediatric emergency with variable clinical outcomes. Following the introduction of coin currency in Saudi Arabia in 2017, a notable shift in ingestion patterns has been reported. This study aimed to evaluate the epidemiology, clinical characteristics, management strategies, and outcomes of pediatric FBI cases presenting to King Saud University Medical City (KSUMC), Riyadh, over a 10-year period. METHODS: A retrospective cohort study was conducted including children aged ≤ 14 years who presented with FBI between 2013 and 2023. Cases were identified through electronic medical records. Data collected included demographics, clinical presentation, type and site of foreign body, diagnostic modality, management approach, complications, admission status, and length of stay (LOS). Comparative analyses were performed across time periods, and regression models were used to identify factors associated with hospital admission and LOS. Statistical significance was set at p < 0.05. RESULTS: A total of 89 pediatric patients were included, with a median age of 5 years (IQR 3, 8); 68.5% were male. Coins were the most commonly ingested objects (58.4%), followed by button batteries (11.2%). The esophagus was the most frequent site of impaction (48.3%) and was strongly associated with endoscopic intervention (p < 0.001), whereas gastric and distal bowel foreign bodies were predominantly managed conservatively. Symptomatic presentation significantly increased the likelihood of hospital admission, particularly in patients presenting with vomiting or drooling. Increasing age independently predicted both admission and longer LOS, while observation-only management was associated with reduced admission rates and shorter hospitalization. Complications were uncommon (4.5%), with no major adverse outcomes observed. CONCLUSION: Coin ingestion remains the predominant form of pediatric FBI following Saudi Arabia's currency transition, with esophageal impaction driving the need for endoscopic intervention. Age, symptomatology, and site of impaction significantly influence admission and LOS. These findings support risk-stratified triage, conservative management for low-risk cases, and targeted preventive strategies, particularly for high-risk objects, such as button batteries. A risk-stratified emergency management framework, summarized in a decision-making flowchart, supports safe triage of pediatric FBIs in tertiary emergency settings.