Foreign body ingestion in children: impact of a digital app on clinical decision-making

Background: Foreign Body Ingestion (FBI) is a common reason for paediatric Emergency Department (ED) visits. Although most cases resolve spontaneously, a significant proportion requires urgent intervention. Adherence to standardised, evidence-based protocols is essential to prevent complications and ensure appropriate care. Methods: This retrospective, single-centre study analysed all paediatric FBI cases over a four-year period. Demographic, clinical, and management data were retrieved and compared with international guidelines and recommendations from the Corpi Estranei mobile application, a digital decision-support tool derived from North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and European Society for Gastroenterology, Hepatology and Nutrition (ESPGHAN) protocols. Results: A total of 475 confirmed cases were identified (59.6% males). Most patients were aged 2-5 years (50.3%), and blunt objects were the most frequently ingested items (82.5%). Most children were asymptomatic (72.6%), while 26% required hospitalisation. Among admitted patients, 64.7% underwent endoscopic or surgical intervention. Interhospital transfers significantly increased hospitalisation rates; however, 37% of transfers were potentially avoidable. Fifteen cases (3.2%) deviated from guideline-based management, mainly due to unnecessary or delayed procedures or omitted imaging, most of which involved transferred patients (p < 0.05). Conclusions: Management of paediatric FBI remains heterogeneous, with frequent deviations from recommended protocols and a notable rate of avoidable transfers and procedures. This study suggests that structured decision-support algorithms may help reduce avoidable transfers and improve guideline adherence in regional paediatric networks.