Abstract
BACKGROUND: The widespread use of small and powerful neodymium magnets in consumer products has led to a significant rise in paediatric magnet ingestion. The ingestion of multiple magnets poses serious risks, including bowel obstruction and perforation. Evidence-based Clinical Practice Guidelines (CPGs) are necessary to inform clinicians of the safest and most effective management strategies across a range of healthcare settings. AIM: This systematic review aims to summarise existing CPGs for diagnosing and managing paediatric magnet ingestion, evaluate the supporting evidence, highlight variation and consensus, and identify areas requiring further research. METHODS: MEDLINE, Scopus, the Cochrane Library, Web of Science and Embase were searched to identify CPGs. Study characteristics, investigation and management recommendations, and indications for conservative management, endoscopy, surgery and discharge with and without follow-up were extracted. Two reviewers independently assessed CPG quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. RESULTS: 25 CPGs were included. Recommendations varied for diagnostic imaging, management of single and multiple magnet ingestion and the use of conservative, endoscopic or surgical interventions. However, there was consensus that: abdominal X-ray is the preferred first-line imaging modality, conservative management is recommended for asymptomatic single magnets, endoscopic removal is recommended for prepyloric asymptomatic multiple magnets and surgery for symptomatic multiple magnets. AGREE II appraisal revealed poor scores in CPG Applicability, Stakeholder Involvement and Rigour of Development, but strong scores for Editorial Independence. Existing CPGs for paediatric magnet ingestion are based on low-quality evidence or expert consensus. CONCLUSIONS: This review highlights inconsistencies and areas of consensus in current CPGs for paediatric magnet ingestion. Variations underscore the need for standardised, evidence-based guidelines to optimise care for affected children. Future research should focus on addressing gaps in evidence and consensus to ensure consistent management across healthcare settings.