Practice guidelines need to include information for

Practice guidelines need to include information for parents. There is no rationale for advising parents to search through their children’s stool daily for the FBs. Discharge information should include advice on recognising the symptoms and signs of intestinal obstruction or perforation should the FB not pass spontaneously (for example, due to it prostanoid receptors being lodged at the pylorus or ileocaecal valve).
The best modality for removal of the FB will depend on many factors, including the patient’s age and clinical condition, the size and shape of FB, type of FB, anatomic location, and the skill of the attending physician. Endoscopy is the most common method used to retrieve ingested FBs. In this study 14% of patients undergoing endoscopic removal suffered complications but the majority were self-limiting and none resulted in long-term morbidity. No deaths were recorded, which agrees with the low mortality rates associated with FB ingestion worldwide.
From these data, most FBs located in the oesophagus were removed. This is contrary to evidence that suggests FBs located in the distal oesophagus have a 30% chance of passing spontaneously and can be left in the oesophagus for 24h before it becomes mandatory to remove them. This practice of early removal is likely due to limited local resources (which makes reducing inpatient duration critical) and to high rates of loss to follow up when such patients are not admitted for observation.


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African relevance

One of the main challenges for emergency health care services in low to middle income countries (LMICs) is their limited capacity to deal with heavy emergency caseloads. The process of triage is one mechanism for mitigating this challenge.
Triage aims to determine a patient’s urgency for medical care (defined as their acuity level) in order to separate critically ill patients, who need immediate lifesaving interventions, from patients who need medical attention but can safely wait to be seen. Triage is recognised as being one of the core requirements for the provision of effective emergency care, and has been shown to reduce patient morbidity and mortality. In LMIC settings, however, triage remains under-used and under-researched, particularly in the area of paediatric emergency care.
The triage of adults and children relies on different triage scales in order to take account of physiological differences between the two. Very few paediatric triage scales exist for the triage of children in LMIC settings. Until recently, the most widely recommended scale was the Emergency Triage Assessment and Treatment (ETAT) system developed in 1998 by the World Health Organisation. However, this scale is only applicable for use in children under five. The South African Triage Scale (SATS) – developed in 2004 by the Cape Triage Group – is the only other triage scale designed specifically for LMIC settings, and one of its advantages over the ETAT, is that Pulse-chase experiments includes scales for the triage of infants and children up to the age of 12years. The main issue with both the paediatric versions of the SATS and the ETAT is that they are not formally validated in various contexts of use.
Validating a triage system in many contexts remains a challenge due to lack of a gold standard. To circumvent this, various studies have assessed validity using surrogate outcome markers such as mortality rates, resource utilisation, and length of hospital stay as proxies for true acuity level. In LMICs, however, reliance on such surrogate markers is difficult due to varying levels of care, lack of basic resources, and poor record keeping. As an alternative, Twomey et al. have recommended using the modified Delphi method to develop an objective reference standard against which to evaluate a triage scale. The Delphi method is a consensus-building technique, which, in the context of triage validation, can be used to develop a set of reference vignettes (short written case reports based on real emergency centre (EC) cases). This methodology has been used by Twomey et al. to assess the validity of the adult version of the SATS.