Teen’s mysterious hospitalization shows hidden danger of grilling out

Posted at 1:38 PM, Apr 06, 2016
and last updated 2016-04-06 15:38:24-04

Last winter, a team of doctors at Nemours/Alfred I. duPont Hospital for Children in Delaware treated a 16-year-old girl who had a sharp pain in one spot of her abdomen.

Although the doctors suspected she had swallowed something, they were surprised when they pulled out a wire bristle from a grill brush during surgery.

It started to make sense when the doctors thought about the girl's history.

She had been on vacation with her family the week before she developed the pain.

They had been barbecuing and the girl remembered that one of her relatives cleaned the grill with a brush.

A bristle from the brush probably fell onto the grill and then stuck onto the hamburger the girl ate.

"This is a great example of a situation where it is not a very common occurrence, but if physicians are aware there's a potential for injury, they can explore the patient's history" to see if a grill brush bristle injury could be involved, said Dr. Matthew Di Guglielmo, a pediatrician at Nemours/Alfred I. duPont Hospital for Children who was part of the team that treated the girl and wrote an article about her case that was published last August.

A new study published on Wednesday gives insight into how often these injuries happen in the United States.

Researchers found that, between 2002 and 2014, there were 43 cases in the National Electronic Injury Surveillance System, a group of about 100 emergency departments in U.S. hospitals that track injuries from consumer products.

Based on this number, the researchers estimated there were a total of 1,698 grill brush injuries in emergency departments nationwide from 2002 to 2014, or about 130 per year.

"Our numbers in the study are not huge, especially if you look in terms of other injuries," said Dr. C.W. David Chang, associate professor of clinical otolaryngology at the University of Missouri, and lead author of new study, which was published in the journal Otolaryngology-Head and Neck Surgery. For example, it is much more common for children to swallow batteries, and those injuries account for more than 5,000 trips to emergency departments in the United States in 2009.

However, the study could have missed some grill brush injuries. People could have gone to urgent care clinics rather than the hospital and thus would not have been included in the current study's estimate, said Chang, who has not treated patients with these injuries, but got interested in the topic after hearing from physicians who had.

Understanding 'outdoor grilling hazards'

The study found that people of all ages have fallen victim to grill brush injuries, but it was most common among people younger than 18, who made up 40% of the cases, and adults age 19 to 40, who made up 30% of cases. Not surprisingly, most injuries happened during the summer and numbers peaked in July. After all, what is a July 4 party without a cookout on the grill?

Although the study had limited data about the outcomes of the injuries, there is reason to think things generally worked out fine. Seventy percent of people were treated in the emergency department and released, but another 28% had to be admitted to the hospital. Based on the National Electronic Injury Surveillance System, as well as case reports from doctors and the Safer Products government database, the study found that most bristles were lodged in the mouth or throat, and in these cases they could usually be "plucked out in the ER," Chang said.

In the rare event that a bristle makes its way all the way down to the intestine, it becomes a concern that the bristle could push its way through the wall of the intestine, as was the case for Di Guglielmo's 16-year-old patient. "It was somewhat remarkable" that she did not develop an infection due to the bristle puncture, which could have been a serious complication, Di Guglielmo said.

Even if a bristle stays in the neck area, there is concern that it could migrate into the soft tissue and require surgery to remove, said Evan J. Harlor, a doctor of osteopathic medicine in the department of Otolaryngology--Head and Neck Surgery at Geisinger Medical Center in Pennsylvania.

Several years ago, Harlor saw a woman in her 40s who developed discomfort in her throat several hours after eating a piece of chicken from the grill. There was a bristle in her throat that he was able to remove without surgery. Harlor and his colleagues published an article in 2012 on this "outdoor grilling hazard" in which they describe the woman's case and five others.

Don't brush off the dangers

There are steps people can take to reduce the hazard. Although it is important to wipe the grill down after using it, "I would advocate inspecting the grill after cleaning to make sure nothing is adhered to it," Chang said.

There are also alternatives to wire bristle grill brushes, such as brushes with nylon bristles and wire mesh brushes. "I think I would definitely [use one of these alternatives] given the number of incidents, at least anecdotally among physicians, to hopefully reduce the risk of injury," Chang said. And for those die-hard metal brush users, you should "definitely look at your brush, and if the bristles are frazzled or frayed, you should probably get it replaced," he added.

"Usually I tell people it is fine if they want to use a wire brush, but after they use it to get a cloth to wipe down the grill surface and really inspect it before they start cooking on it," Harlor said.

A report by the Centers for Disease Control and Prevention about grill brush injuries in Rhode Island between 2011 and 2012 said it is unclear whether different brands of brushes or types of grills or foods pose greater risk.

Even though grill brush injuries are less common than swallowing a fish or chicken bone, or children swallowing a coin or battery, "I could see [these injuries] going worse," Di Guglielmo said. Wire bristles tend to be sharp, so the risk of them puncturing the digestive tract and causing an infection could be greater, he added.