Button Battery Ingestion — Clinical Decision Support

Button Battery Ingestion — Clinical Decision Support Tool

An evidence-informed clinical decision support tool for the assessment and management of paediatric button battery ingestion.

Developed to support early recognition of potentially life-threatening delayed vascular complications, including delayed arterio-oesophageal fistulas, occult vascular erosion, and other major vascular injuries that may present days to weeks after battery removal.

Version 1.0 · 2026 CC BY-NC 4.0 DOI: 10.17605/OSF.IO/UTS7N

Clinical Development

Concept & Lead Developer

Francesco Pierangeli, MD

Paediatric Surgeon

Pediatric Surgery Unit

Salesi Children’s Hospital — Marche Polytechnic University, Ancona, Italy

Clinical Review & Multidisciplinary Feedback

Alba Cruccetti, MD

Paediatric Surgery

Fabiano Nino, MD

Paediatric Surgery

Edoardo Bindi, MD

Paediatric Surgery

Nora Prendushi, MD

Anaesthesia & Intensive Care

Lucia Amici, MD

Radiology

Mario Brusco, MD

Clinical Feedback & Paediatric Gastroenterology Review

Simona Gatti, MD

Paediatric Gastroenterology Review

Maria Elena Lionetti, MD

Paediatrics

Giovanni Cobellis, MD

Senior Clinical Supervision

Developed within a multidisciplinary clinical environment involving paediatric surgery, gastroenterology, radiology, anaesthesia, intensive care, and paediatrics.

Institutional Affiliation

Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona
Ospedale Pediatrico G. Salesi — Pediatric Surgery Unit
Università Politecnica delle Marche
Ancona, Italy

doi.org/10.17605/OSF.IO/UTS7N

Evidence Base

This tool integrates:

Published paediatric literature on button battery–related vascular complications and delayed haemorrhage
Available case reports, case series, and observational evidence regarding delayed arterio-oesophageal fistula formation and vascular erosion
Current international recommendations, including ESPGHAN/NASPGHAN guidance
Multidisciplinary clinical review

Key References

Roggero A et al. Pediatr Surg Int 2024; 40:268.

Oliva S et al. Dig Liver Dis 2020; 52:1266–1281.

Mubarak A et al. J Pediatr Gastroenterol Nutr 2021; 73:129–136.

Leinwand K et al. Gastrointest Endosc Clin N Am 2016; 26:99–118.

Clinker C et al. J Pediatr Surg 2026; 61:163066.

Evidence remains limited and evolving in several high-risk clinical scenarios. Recommendations should therefore be interpreted proportionately to individual clinical context.

This tool is intended to complement — not supersede — current ESPGHAN/NASPGHAN recommendations in areas where evidence remains limited.

Intended Use

For qualified healthcare professionals only.

This tool supports — but does not replace — specialist clinical judgement.

Recommendations should always be interpreted alongside:

institutional protocols
specialist consultation
clinical examination
radiologic and endoscopic findings
multidisciplinary discussion when appropriate

Clinical presentations may vary substantially, and individual patient factors must always guide management.

⚠ Important Clinical Note

Haemodynamic stability does not exclude vascular risk following button battery ingestion.

Minor bleeding, sentinel symptoms, or apparently reassuring findings may occasionally precede catastrophic deterioration.

Clinical suspicion should remain proportionate to the overall risk profile and clinical context.

Citation

If this tool contributes to clinical practice, education, or academic work, please cite:

Pierangeli F, et al. Button Battery Ingestion — Clinical Decision Support Tool. OSF Repository (2026).
DOI: 10.17605/OSF.IO/UTS7N

License

Creative Commons Attribution–NonCommercial 4.0 International (CC BY-NC 4.0)

Free for non-commercial educational and clinical use with attribution.