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Intussusception in infants and children: feasibility of ambulatory management
A Le Masne1, S Lortat-Jacob, N Sayegh
1Paediatric Emergency Department, Hôpital Necker Enfants Malades, Paris, France.
Insights
Ambulatory management of ileo-colic intussusception in children is safe and cost-effective. This approach reduces hospital stays and costs compared to traditional inpatient treatment, promoting efficient care.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Surgical Outcomes
Background:
- Intussusception is a common surgical emergency in infants and children.
- Traditional management often involves prolonged hospitalization.
- Evaluating ambulatory care models can improve efficiency and reduce costs.
Purpose of the Study:
- To assess the feasibility and outcomes of ambulatory management for ileo-colic intussusception.
- To determine if outpatient treatment can shorten length of stay and reduce healthcare costs.
- To identify factors influencing the success of ambulatory management.
Main Methods:
- Retrospective study of 113 children treated for ileo-colic intussusception over 3 years.
- All patients underwent attempted barium enema reduction.
- Data collected on management approach (ambulatory vs. inpatient), reduction success, and outcomes.
Main Results:
- Successful reduction rate via barium enema was 81%.
- 44.2% of patients were managed entirely on an ambulatory basis.
- Ambulatory management resulted in significant cost savings ($1000/case) compared to inpatient care.
Conclusions:
- Outpatient management of acute ileo-colic intussusception is a secure and cost-saving strategy.
- Successful implementation requires medical team commitment and adapted hospital funding models.
- Ambulatory care for intussusception can enhance resource utilization in pediatric emergency departments.
Abstract:
To evaluate the ambulatory management of ileo-colic intussusception in infants and children, a retrospective study over 3 years of 113 children treated for ileo-colic intussusception in a paediatric emergency department was undertaken with the aim of shortening the length of stay. A total of 113 children aged 10 days to 9 years (median 12 months) were treated for intussusception between January 1993 and December 1996. None had septic shock or peritoneal aeric effusion. Barium enema reduction was attempted in all patients. Successful reduction rate was 81%. Fifty patients (44.2%) were completely ambulatory managed and 42 were hospital-supervised after successful enema reduction. Twenty-one children underwent laparotomy after failure of enema. With the ambulatory device, costs were reduced ($1000/case) compared with conventional in-patient treatment. Outpatient treatment of acute ileo-colic intussusception is secure and reduces costs. It depends on the willingness of the medical team but requires simultaneous adaptation of hospital funding to promote this trend.