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RSNA: Kids Still Swallow Soda Tabs

— CHICAGO -- Pop-top tabs are supposed to stay on soda cans, but they may still end up in children's stomachs, a researcher said.

MedpageToday

CHICAGO -- Pop-top tabs are supposed to stay on soda cans, but they may still end up in children's stomachs, researchers said here.

So-called "stay-tabs" were introduced in the 1970s as an alternative to pop-tops that completely severed from aluminum cans.

But researchers at the Radiological Society of North America meeting say the prevalence of swallowed stay-tabs may be more common than previously thought because they're harder to spot on radiographs than other objects that kids ingest -- such as pennies.

Lane F. Donnelly, MD, of Cincinnati Children's Hospital, found 19 cases of swallowed tabs over a 16-year period at his institution.

Action Points

  • Explain that despite a redesign that's supposed to keep them attached to to the can, the prevalence of swallowed soda and beer pop-tops may be more common than previously thought. They're often hard to spot on radiographs.
  • Note that this study was published as an abstract and presented at a conference. The findings should be considered preliminary until published in a peer-reviewed journal.

"It's probably a much larger number nationwide," he said. "The movement from pull-tabs to stay-tabs has not eliminated the problem of inadvertent swallowing of tabs."

He was prompted to investigate when a pediatric patient arrived at the hospital after swallowing one of the tiny aluminum tabs. Aluminum is a much less radio-dense metal than others, so the tabs can be relatively hard to spot on X-rays, as Donnelly noticed with this patient.

So he looked for all cases of tab-swallowing at the hospital, as well as information on whether the tab could be easily spotted on an image.

He found the prevalence to be much higher than expected, especially since the new tabs were designed to prevent swallowing.

They became popular, Donnelly said, because drinkers often put the original, removable tabs into the soda or beer can after opening at the urging of environmentalists, who argued that they would otherwise end up as litter.

A 1975 study in the Journal of the American Medical Association highlighted three cases of accidental ingestion -- one of which resulted in aspiration. However, Donnelly said no prevalence estimates are available.

Among the 19 cases Donnelly found, the mean age was 8.5 years, and 79% of patients were over age 5. There were 11 boys and eight girls.

Stay-tabs could only be identified in four images, or 21% of the total.

"Even if you have a radiograph that does not show a stay-tab doesn't mean the child didn't ingest it," he said.

Pointing to a slide with one of the identifiable tab images, Donnelly said "You can see how poorly it shows up." By comparison, he showed an image of a swallowed penny, which was an obvious, bright, bold disk.

He said that none of the 19 cases needed surgery, and all were managed conservatively with fluids and observation, and in the case of one report, with this helpful advice: "No sucking on can tops."

"A high percentage of patients [who swallow tabs] do well," Donnelly said. But he noted that tabs can lacerate the bowel and lead to injury or perforation, or they can become lodged in the gastrointestinal tract, leading to obstruction.

He said patient education about the dangers of swallowing tabs and possibly a can redesign may be in order.

Joseph Tashjian, MD, of St. Paul Radiology in Minnesota, who moderated the press briefing, said that with the original pull-tabs, surgery had been required to remove the devices.

"The positive thing is that all these patients were able to be managed conservatively," he said. However, Tashjian suggested further studies were needed to improve safety further.

Disclosures

The researchers reported no conflicts of interest.

Primary Source

Radiological Society of North America

Source Reference: Donnelly L "Did the introduction of the beverage can stay-tab in the mid-1970s fail to reduce the number of inadvertent ingestions as compared to the previous detachable pull tabs?" RSNA 2009; Abstract SSE20-03.