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Patterns of management of intussusception outside tertiary centres
F R Calder1, S Tan, L Kitteringham
1Department of Paediatric Surgery, University Hospital Lewisham, Lewisham, London, England.
Insights
Management of pediatric intussusception in district general hospitals is not standardized. This survey highlights variations in resuscitation, imaging, and reduction techniques, indicating a need for improved protocols to ensure optimal outcomes for children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Radiology
Background:
- Intussusception is a common pediatric surgical emergency.
- Outcomes are excellent in expert hands, but many cases occur in district general hospitals (DGH) without specialist pediatric surgeons.
Purpose of the Study:
- To clarify current management patterns for pediatric intussusception in DGHs.
- To identify variations in diagnostic and therapeutic approaches.
Main Methods:
- A postal survey was conducted among consultant pediatricians, radiologists, and general surgeons in a populous region of England.
- 141 consultants responded, representing similar proportions from each specialty.
Main Results:
- Significant variation exists in resuscitation responsibility (pediatricians favored), diagnostic imaging (ultrasound preferred), and contrast agents for radiologic reduction (paediatricians favored air/saline, surgeons water-soluble, radiologists barium).
- 53% would transfer patients to a tertiary center before reduction, while 42% would attempt it locally. Post-failed reduction, 23% would consider transfer.
- Most consultants (84%) manage fewer than 5 cases annually. Awareness of clinical policies for pediatric intussusception management was low (16%).
Conclusions:
- Management of pediatric intussusception outside tertiary centers is non-uniform and lacks standardization.
- Improvements in protocols and potentially increased centralization or specialized training are necessary for better patient outcomes.
Background/Purpose:
Intussusception is a common problem in young children and should have an excellent outcome in expert hands. Many children are treated in district general hospitals (DGH), which do not have specialist paediatric surgeons. The aim of this study was to clarify current patterns of management for such patients.
Methods:
The authors conducted a postal survey of DGH consultant paediatricians, radiologists, and general surgeons in a populous region of England.
Results:
One hundred forty-one (44%) consultants who responded comprised similar proportions of consultants from each specialty. Most respondents (79%) thought that in their location paediatricians should take responsibility for resuscitation of children with suspected intussusception. Two-thirds indicated that abdominal ultrasound scan, either alone or in combination with another modality, was their investigation of choice for confirming the diagnosis. Preferences for contrast medium for radiologic reduction varied; paediatricians favoured air (46%) or saline (28%), surgeons preferred water-soluble contrast (58%), and radiologists preferred to use barium (49%). Fifty-three percent of consultants indicated they would transfer a child with confirmed intussusception to a tertiary centre before attempting reduction, 42% would attempt reduction locally, and 5% would operate locally without attempting radiologic reduction. After failed reduction, a further 23% of consultants would consider transfer, but the remainder would operate locally. Only 13% of paediatricians thought that their surgeons had appropriate facilities and support to operate on intussusception, but 36% of surgeons claimed to be doing so. Most consultants (84%) admitted seeing fewer than 5 cases per year; 98% of surgeons were in this group. Only 16% of consultants (mostly paediatricians) were aware of any written clinical policy for managing paediatric intussusception in their hospital.
Conclusion:
This study shows that the management of paediatric intussusception outside tertiary centres is not uniform or standardised, and that improvements are necessary. J Pediatr Surg 36:312-315.
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