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Figure.  Emergency Department Visits for Magnet Ingestions in Patients ≤17 Years Old, 2009-2019
Emergency Department Visits for Magnet Ingestions in Patients ≤17 Years Old, 2009-2019

Scatterplot of weighted rates per 100 000 persons; linear regression trend lines are shown for interrupted time series. The slope for pre–Consumer Product Safety Commission (CPSC) involvement was 0.59 (95% CI, 0.48-0.70; P < .001); the slope during the rule was −0.28 (95% CI, −0.39 to −0.17; P = .01); and the slope after the rule was vacated was 0.30 (95% CI, 0.12-0.48; P = .05). The change in slope before involvement vs during the rule was 0.87 emergency department visits per 100 000 persons annually (95% CI, 0.71-1.03; P < .001); the change in slope during the rule vs after it was vacated was −0.58 emergency department visits per 100 000 persons annually (95% CI, −0.68 to −0.47; P = .007).

Table.  Emergency Department Visits for Magnet Ingestions Around Federal Rule Changes in Patients Aged 0 to 17 Years in the United States, 2009-2019
Emergency Department Visits for Magnet Ingestions Around Federal Rule Changes in Patients Aged 0 to 17 Years in the United States, 2009-2019
1.
Reeves  PT, Nylund  CM, Krishnamurthy  J, Noel  RA, Abbas  MI.  Trends of magnet ingestion in children, an ironic attraction.   J Pediatr Gastroenterol Nutr. 2018;66(5):e116-e121. doi:10.1097/MPG.0000000000001830 PubMedGoogle ScholarCrossref
2.
Abbas  MI, Oliva-Hemker  M, Choi  J,  et al.  Magnet ingestions in children presenting to US emergency departments, 2002-2011.   J Pediatr Gastroenterol Nutr. 2013;57(1):18-22. doi:10.1097/MPG.0b013e3182952ee5 PubMedGoogle ScholarCrossref
3.
Centers for Disease Control and Prevention.  Gastrointestinal injuries from magnet ingestion in children—United States, 2003-2006.   MMWR Morb Mortal Wkly Rep. 2006;55(48):1296-1300.PubMedGoogle Scholar
4.
Agbo  C, Lee  L, Chiang  V,  et al.  Magnet-related injury rates in children: a single hospital experience.   J Pediatr Gastroenterol Nutr. 2013;57(1):14-17. doi:10.1097/MPG.0b013e318292fa2e PubMedGoogle ScholarCrossref
5.
Consumer Product Safety Commission.  Final rule: safety standards for magnet sets.   Fed Regist. 2014;79(192):59962-59989. Accessed August 5, 2020. https://www.federalregister.gov/documents/2014/10/03/2014-23341/final-rule-safety-standard-for-magnet-setsGoogle Scholar
6.
Consumer Product Safety Commission.  Safety standard for magnet sets; removal of final rule vacated by court.   Fed Regist. 2017;82(43):12716-12717. Accessed August 10, 2020. https://www.federalregister.gov/documents/2017/03/07/2017-04381/safety-standard-for-magnet-sets-removal-of-final-rule-vacated-by-courtGoogle Scholar
Research Letter
November 24, 2020

Pediatric Magnet Ingestions After Federal Rule Changes, 2009-2019

Author Affiliations
  • 1Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Boston, Massachusetts
  • 2Department of Surgery, Boston Children’s Hospital, Boston, Massachusetts
  • 3Department of Radiology, Massachusetts General Hospital, Boston
  • 4Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
JAMA. 2020;324(20):2102-2104. doi:10.1001/jama.2020.19153

Magnet ingestions among children have become a serious health risk after the 2009 introduction of high-powered, rare-earth magnets, commercially sold as small (3- to 6-mm) recreational objects.1,2 These neodymium magnets are 5 to 10 times more powerful than traditional ferrite magnets and are sold as sets for entertainment and toys (eg, Bucky Balls building sets, jewelry kits, spinning toys).3 Ingestion of multiple magnets, or a magnet with a metal object, can result in bowel obstruction, perforation, and death when magnets attach through bowel walls.4 After reports of pediatric injuries and deaths related to ingested neodymium magnets, the Consumer Product Safety Commission (CPSC) initiated campaigns to limit sales in 2012 with voluntary recalls and safety standards.5 Other CPSC efforts included awareness campaigns, legislative advocacy, and lawsuits.1 In October 2014, the CPSC published its final rule, Safety Standard for Magnet Sets, prohibiting sales of these small high-powered magnet sets.3 In November 2016, this rule was legally remanded by the US Court of Appeals 10th Circuit after being challenged by Zen Magnets LLC, resulting in a resurgence of these magnets on the market.6 This study examined trends in US emergency department (ED) visits for pediatric magnet ingestions over the period of the changes in federal regulations.

Methods

Data from the National Electronic Injury Surveillance System (NEISS), a national sample of US injury-related ED visits, were obtained for January 1, 2009, through December 31, 2019. Magnet ingestions were identified for children aged 17 years or younger with NEISS diagnosis codes of ingested object (41) or aspirated object (42). Only narratives with the key word magnet were included. We used US Census data, NEISS sample weights, and clusters to calculate age-specific weighted rates of ED visits for ingestions per 100 000 persons of the population. An interrupted time-series analysis using linear regression modeling examined trends during 3 periods: (1) 2009-2012, before CPSC involvement; (2) 2013-2016, during the CPSC federal rule (including increasing CPSC regulations); and (3) 2017-2019, after the CPSC rule was vacated. Mean ED visit rates for each period and slope changes between periods were calculated. Analysis of variance was used to compare demographics. A 2-sided P < .05 was considered significant. Data were analyzed with SAS version 9.3 (SAS Institute Inc) using SURVEYFREQ, SURVEYREG, and SURVEYLOGISTIC, and R for regression analyses (2020; R Foundation). This study was deemed exempt by the Partners Healthcare Institutional Review Board.

Results

A total of 36 701 ED visits were identified for ingested or aspirated objects; 1421 met criteria for magnet ingestions (aged ≤17 years; Table). Those aged 5 years or younger had the highest rate of ED visits (n = 847; weighted rate, 7.0 [95% CI, 5.0-9.0] per 100 000 persons). Following 2012 CPSC involvement, ED visit rates decreased from an aggregate mean of 3.58 (95% CI, 2.20-4.96) per 100 000 persons to 2.83 (95% CI, 1.60-4.06) per 100 000 persons in 2013-2016 (slope change, 0.87 [95% CI, 0.71-1.03] ED visits per 100 000 annually). From 2016 to 2019, the mean ED visit rate increased to 5.16 (95% CI, 3.22-7.11) per 100 000 persons, with an overall upward trend (slope change,−0.58 [95% CI, −0.68 to −0.47] per 100 000 persons annually; Figure). Admissions from the ED increased throughout the study period (Table). The mean number of ED visits among those aged 5 years or younger, boys, and White and Black children significantly differed among the 3 periods, with increases after the CPSC rule was remanded.

Discussion

The removal of the Safety Standard for Magnet Sets rule was associated with increased ED visit rates for magnet ingestions among children aged 17 years or younger. This followed a decline in magnet ingestions between 2012 and 2016 after CPSC advocacy and the institution of this rule, consistent with previous findings.1 In contrast, ED admissions consistently increased over the 3 periods, but the ED disposition variable in NEISS is limited, without information on the reason for admission, outcome, or severity of the injury. Further study is needed to examine clinical outcomes. Other limitations include using a national ED-based database with possible injury mechanism misclassification. All magnet-related ingestions were analyzed because high-powered magnets (which are more likely to cause intestinal injury) could not be specifically identified in this data set.

Effective prevention of magnet-related ingestions can be achieved with industry regulations, as evidenced by the now-remanded CPSC safety standard. Removal of this rule is associated with increases in ED visits for magnet ingestions. Given that associated deaths and injuries to children are preventable, industry standards should be reconsidered.

Section Editor: Jody W. Zylke, MD, Deputy Editor.
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Article Information

Corresponding Author: Michael R. Flaherty, DO, Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, 175 Cambridge St, Boston, MA 02114 (mrflaherty@partners.org).

Correction:This article was corrected on January 19, 2021, to revert the Table’s percentages and P values for the age group rows of 6 through 11 years and 12 through 17 years.

Accepted for Publication: September 10, 2020.

Author Contributions: Drs Flaherty and Lee had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Flaherty, Buchmiller, Lee.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Flaherty, Lee.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Flaherty, Vangel.

Supervision: Buchmiller, Lee.

Conflict of Interest Disclosures: Dr Flaherty reported receiving support from the Massachusetts Medical Society. Dr Lee reported receiving support from the American College of Surgeons and UpToDate. No other disclosures were reported.

References
1.
Reeves  PT, Nylund  CM, Krishnamurthy  J, Noel  RA, Abbas  MI.  Trends of magnet ingestion in children, an ironic attraction.   J Pediatr Gastroenterol Nutr. 2018;66(5):e116-e121. doi:10.1097/MPG.0000000000001830 PubMedGoogle ScholarCrossref
2.
Abbas  MI, Oliva-Hemker  M, Choi  J,  et al.  Magnet ingestions in children presenting to US emergency departments, 2002-2011.   J Pediatr Gastroenterol Nutr. 2013;57(1):18-22. doi:10.1097/MPG.0b013e3182952ee5 PubMedGoogle ScholarCrossref
3.
Centers for Disease Control and Prevention.  Gastrointestinal injuries from magnet ingestion in children—United States, 2003-2006.   MMWR Morb Mortal Wkly Rep. 2006;55(48):1296-1300.PubMedGoogle Scholar
4.
Agbo  C, Lee  L, Chiang  V,  et al.  Magnet-related injury rates in children: a single hospital experience.   J Pediatr Gastroenterol Nutr. 2013;57(1):14-17. doi:10.1097/MPG.0b013e318292fa2e PubMedGoogle ScholarCrossref
5.
Consumer Product Safety Commission.  Final rule: safety standards for magnet sets.   Fed Regist. 2014;79(192):59962-59989. Accessed August 5, 2020. https://www.federalregister.gov/documents/2014/10/03/2014-23341/final-rule-safety-standard-for-magnet-setsGoogle Scholar
6.
Consumer Product Safety Commission.  Safety standard for magnet sets; removal of final rule vacated by court.   Fed Regist. 2017;82(43):12716-12717. Accessed August 10, 2020. https://www.federalregister.gov/documents/2017/03/07/2017-04381/safety-standard-for-magnet-sets-removal-of-final-rule-vacated-by-courtGoogle Scholar
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