It might have escaped your notice but the team at DFTB recently had a paper published by the Journal of Paediatrics and Child Health that has garnered a lot of interest.
Tagg, A., Roland, D., Leo, G.S., Knight, K., Goldstein, H., Davis, T. and Don’t Forget The Bubbles, 2019. Everything is awesome: Don’t forget the Lego. Journal of Paediatrics and Child Health, 55(8), pp.921-923.
We are sure you have questions. Lots of questions. So we thought we should answer them for you in the best way we know how.
What pressing scientific question did you ask?
We know that coins are the most commonly swallowed foreign object in the paediatric population and there is a lot of data surrounding transit time. The second most commonly swallowed objects are small toys but there is very little data out there. We wanted to know how long it would take for a small piece of plastic toy, in this case, a Lego head, to pass through.
How on earth did you come up with the idea?
In one of our regular editorial meetings we were discussing some of our upcoming publications and musing how we could do something a little lighter, akin to the great Peppa Pig paper in last year’s Christmas BMJ. And then Andy Tagg said, “I’ve got this idea but you might think it a bit strange.” Within a short space of time, we had an international team of researchers literally chomping at the bit to undertake the study.
Did you really swallow those poor heads?
Of course, we did! Do you want proof?
Then what happened?
We waited to see what would happen. We all know corn kernels can whip through the colon in seemingly no time at all, but what about a little yellow piece of plastic? There was really only one way to find out.
And you searched through your own poo to find them? How?
As with any piece of research, it is important to have a robust search strategy in place prior to commencement. A variety of techniques were tried – using a bag and squashing, tongue depressors and gloves, chopsticks – no turd was left unturned. And although we only used a very small sample size the fact that one of our heads went missing suggests that you really shouldn’t worry if you can’t find it.
What happened to the missing head?
Who knows? Perhaps one day many years from now, a gastroenterologist performing a colonoscopy will find it staring back at him.
But what about Ben Lawton? Where was he when all this was going on?
Don’t Forget the Bubbles was founded by four curious doctors – Tessa Davis, Andy Tagg, Henry Goldstein and Ben Lawton. Unfortunately Ben was travelling at the time we undertook the study and we didn’t think searching through his colonic contents in an aeroplane toilet was exactly fair.
And then you kept it quiet, right?
It can take an average of 17 years for science to go from bench side to bedside. Leveraging social media we managed to go from online publication on a Thursday evening to global saturation by Saturday evening.
We’ve finally answered the burning question – how long does it take for an ingested lego head to pass?
THIS is dedication to paediatrics – but it was worth it to advance science and paediatric emergency care.https://t.co/tZ4b9Yo8Kf pic.twitter.com/Nda7rqs7Zl
— Tessa Davis (@TessaRDavis) November 23, 2018
By Saturday morning Damian Roland was speaking on Canadian radio and the DFTB group made Forbes, ars technica, and the BBC World Service by the afternoon.
But surely this isn’t hard science?
Sadly I don’t get this.
It’s funny and interesting but wrong patient group, single type of FB, tiny sample size.
It’s not EBM and should not change practice.
We often hear from PEM that children are not just little adults
6 adults are not all children #sorry #notEBM https://t.co/LYbxKSxD9H
— Simon Carley (@EMManchester) November 24, 2018
Of course, it’s not, it’s a bit of fun in the run-up to Xmas.
With such a small sample size it is important that you don’t extrapolate the data to the entire population of Lego swallowers. Anecdata from Twitter suggests that a large number of people accidentally ingested bits of Lego throughout their life with no adverse effects*.
It is also worth noting that most people who swallow Lego are children, not fully grown adults. Data that is applicable to the adult population may well not be applicable to children.
For a more scientific approach to ingested foreign bodies in children then take a look at these two papers.
Yeh HY, Chao HC, Chen SY, Chen CC, Lai MW. Analysis of Radiopaque Gastrointestinal Foreign Bodies Expelled by Spontaneous Passage in Children: A 15-Year Single-Center Study. Frontiers in pediatrics. 2018;6:172.
Macgregor D, Ferguson J. Foreign body ingestion in children: an audit of transit time. Emergency Medicine Journal. 1998 Nov 1;15(6):371-3.
You may also enjoy exploring the following posts about foreign bodies on DFTB:
Andy’s blog post on Foreign Body Ingestion
Chantal McGrath’s DFTB17 talk Batteries Not Included on button battery ingestion
A case study by Loren on ‘the magic coin’
What’s next for the group?
Whilst this may be the pinnacle of our publishing careers we hope we have not peaked too early. Next up is finalizing all the details for our upcoming conference in London – www.dftb19.com, and then? Who knows?
*Please do not try this at home.
DFTB in the papers
CBC Radio Canada – As it happens