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Management of the child after enema-reduced intussusception: hospital or home?
Ming Chien1, F Anthony Willyerd, Katherine Mandeville
1Department of Pediatrics, Division of Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona 85016, USA.
Insights
Routine observation after successful enema-reduced intussusception in children is not clearly justified. A short Emergency Department (ED) observation period is a safe alternative to inpatient management.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Clinical Pediatrics
Background:
- Standard practice involves admitting children for observation after enema-reduced intussusception.
- The clinical utility of routine inpatient observation has not been clearly justified.
Purpose of the Study:
- To determine the rate and timing of recurrent intussusception after successful enema reduction.
- To describe any associated complications following enema reduction.
Main Methods:
- Retrospective chart review of children (0-17 years) with enema-reduced intussusception.
- Study period: 7 years (2002-2008) at a tertiary care children's hospital.
- Inclusion criteria: confirmed and uncomplicated enema-reduced intussusception.
Main Results:
- 98 children with successful enema reduction.
- Overall recurrence rate: 7.1% (10 episodes in 7 patients).
- Early recurrence rate (<48h): 2.0%; Late recurrence rate (>48h): 5.1%. No adverse events reported.
Conclusions:
- Low early recurrence rate and minimal risk of adverse outcomes support shorter observation.
- Emergency Department (ED) observation for 6 hours is a safe alternative to inpatient management.
- Results suggest that children with uncomplicated enema-reduced intussusception can be managed on an outpatient basis.
Background:
Standard practice has been to admit children for an observation period after enema-reduced intussusception. However, the utility of such routine practice has not been clearly justified.
Study Objectives:
The main objective was to determine the rate and timing of recurrent intussusception after successful enema reduction and describe any associated complications.
Methods:
The study was a retrospective chart review identifying children with enema-reduced intussusception during a 7-year period from 2002 through 2008. Subjects were children ages 0 to 17 years presenting to the Emergency Department (ED) of a tertiary care, free-standing children's hospital with confirmed and uncomplicated enema-reduced intussusception.
Results:
During the study period there were 98 children with successful enema reduction of intussusception. There were 10 episodes of recurrence in 7 patients, for an overall recurrence rate of 7.1%. Three patients had two recurrences each, and the remainder had single recurrences. Two patients had early recurrences (<48 h) at 3 and 5 h, for an early recurrence rate of 2.0%. The late recurrence rate (>48 h) was 5.1%. No adverse events were noted in any of the recurrences.
Conclusions:
Given the low early recurrence rate for enema-reduced intussusception and the minimal risk of adverse outcomes, ED observation for a 6-h period seems to be a safe alternative to inpatient management. These results support previous work and suggest that these patients can be managed on an outpatient basis.
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