Joseph A Sujka1, Brian Dalton2, Katherine Gonzalez3, Celeste Tarantino4, Lisa Schroeder5, Joan Giovanni6, Tolulope A Oyetunji7, Shawn D St Peter8. 1. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: josephsujka@gmail.com. 2. Department of Surgery, UF College of Medicine, Jacksonville. Electronic address: Brian.dalton@jax.ufl.edu. 3. Johns Hopkins All Children's Hospital, St. Petersburg. Electronic address: katherineschnell@gmail.com. 4. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: ctarantino@cmh.edu. 5. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: lschroeder@cmh.edu. 6. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: gegiovanni@cmh.edu. 7. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: taoyetunji@cmh.edu. 8. Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108. Electronic address: sspeter@cmh.edu.
Abstract
PURPOSE: Pediatric intussusception's first line treatment consists of fluoroscopic guided air enema reduction. Postprocedure, these patients are usually admitted overnight for observation. The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception. METHODS: A prospective observational study was conducted after implementation of an ED protocol for ileocolic intussusception from 10/2014 to 7/2017 and compared these patients to a historical cohort immediately prior to protocol initiation (10/2011-9/2014). Data collected included demographics, total time in the ED and hospital, enema reduction, recurrence, and requirement for operative intervention. Results reported as means with standard deviation and medians reported with interquartile ranges (IQR). RESULTS: 115 patients were treated with the prospective protocol and were compared to a 90 patient historical cohort. Reduction was successful in 84%-89% of cases. Median hospital time after enema was shorter in the protocol group [4.8 h (4.25, 14.97) versus 19.7 h (13.9, 33.45), p < 0.01]. Only 33% of patients were admitted following the protocol; the most common admission reason was persistent abdominal discomfort. CONCLUSION: ED observation and discharge after successful air enema reduction in children with ileocolic intussusception are safe, facilitate early discharge, and reduce hospital resource utilization. LEVEL OF EVIDENCE: III.
PURPOSE: Pediatric intussusception's first line treatment consists of fluoroscopic guided air enema reduction. Postprocedure, these patients are usually admitted overnight for observation. The purpose of our study was to document the results of emergency department (ED) observation and discharge protocol after successful reduction of ileocolic intussusception. METHODS: A prospective observational study was conducted after implementation of an ED protocol for ileocolic intussusception from 10/2014 to 7/2017 and compared these patients to a historical cohort immediately prior to protocol initiation (10/2011-9/2014). Data collected included demographics, total time in the ED and hospital, enema reduction, recurrence, and requirement for operative intervention. Results reported as means with standard deviation and medians reported with interquartile ranges (IQR). RESULTS: 115 patients were treated with the prospective protocol and were compared to a 90 patient historical cohort. Reduction was successful in 84%-89% of cases. Median hospital time after enema was shorter in the protocol group [4.8 h (4.25, 14.97) versus 19.7 h (13.9, 33.45), p < 0.01]. Only 33% of patients were admitted following the protocol; the most common admission reason was persistent abdominal discomfort. CONCLUSION: ED observation and discharge after successful air enema reduction in children with ileocolic intussusception are safe, facilitate early discharge, and reduce hospital resource utilization. LEVEL OF EVIDENCE: III.
Authors: So Hyun Paek; Do Kyun Kim; Young Ho Kwak; Jae Yun Jung; Seuk Lee; Joong Wan Park Journal: Medicine (Baltimore) Date: 2021-12-03 Impact factor: 1.817