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Published on: August 22, 2012
Three-year surveillance of intussusception in children in Switzerland
Michael Buettcher1, Gurli Baer, Jan Bonhoeffer
1Division of Pediatric Infectious Diseases, University Children's Hospital Basel, PO Box 4005, Basel, Switzerland.
Insights
This study tracked childhood intussusception in Switzerland, finding a rare association with rotavirus gastroenteritis. Most intussusception cases occurred in children over one year old.
Area of Science:
- Pediatric epidemiology
- Gastroenterology
- Public health surveillance
Background:
- Intussusception is a significant cause of intestinal obstruction in infants and young children.
- Understanding its incidence and triggers, like gastroenteritis, is crucial for public health strategies.
Purpose of the Study:
- To establish baseline data on the incidence of intussusception in children.
- To investigate the association between intussusception and gastroenteritis, including rotavirus infection.
Main Methods:
- A prospective, nationwide, cross-sectional observational study was conducted in Switzerland from April 2003 to March 2006.
- Data were collected from 38 pediatric units using a standardized questionnaire and verified by capture-recapture analysis.
- The Brighton Collaboration's case definition for intussusception was applied.
Main Results:
- An estimated 381 intussusception episodes occurred, with an underreporting rate of 32% to the surveillance unit.
- The mean annual incidence was 38, 31, and 26 cases per 100,000 live births in the first, second, and third years of life, respectively.
- Gastroenteritis preceded 70 cases, and rotavirus was detected in only 5 of 61 tested patients; most cases occurred beyond infancy.
Conclusions:
- This study provides the first prospective nationwide surveillance of childhood intussusception using a standardized definition.
- The incidence of intussusception in children over one year old is notable.
- The association with rotavirus gastroenteritis was found to be rare.
Objective:
We attempted to obtain baseline data on the incidence of intussusception and its association with gastroenteritis in a cross-sectional observational study in children.
Methods:
Admissions to all 38 pediatric units in Switzerland because of intussusception were reported to the Swiss Pediatric Surveillance Unit from April 2003 to March 2006. Patient and disease characteristics were assessed prospectively with the use of a standardized questionnaire based on the case definition for intussusception developed by the Brighton Collaboration. Completeness of reporting was verified through capture-recapture analysis.
Results:
There were 294 patients with reported intussusception; 35 cases were excluded for various reasons, and 29 additional patients were identified through International Classification of Diseases, 10th Revision, codes. After capture-recapture analysis, we estimated underreporting to the Swiss Pediatric Surveillance Unit to be 32% and we calculated a true number of 381 intussusception episodes. The highest level of diagnostic certainty was reached by 248 patients, and 20 fulfilled level 2 criteria; for the remaining 20 patients, available information was insufficient. The mean age of the patients was 2.7 years. The yearly mean incidence of intussusception was 38, 31, and 26 cases per 100,000 live births in the first, second, and third year of life, respectively, with no apparent seasonality. Seventy patients had a history of coinciding gastroenteritis, and 5 of 61 tested positive for rotavirus. Spontaneous devagination was observed for 38 patients; enemas reduced intussusception successfully in 183 cases, whereas surgical treatment was required in 67. All patients recovered without sequelae.
Conclusions:
This is the first prospective nationwide surveillance of intussusception in childhood using a standardized case definition. Most cases occurred beyond infancy, and association with rotavirus gastroenteritis was rare.
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