Pediatric Intussusception: Decreased Surgical Risk with Timely Transfer to a Children's Hospital
Brian P Blackwood1,2, Christina M Theodorou3, Ferdynand Hebal1
1Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago Ave, Box 63, Chicago.
Insights
Patients transferred from outside hospitals (OSH) for intussusception surgery spent more time at the OSH, increasing their need for operative management. Expedited transfer is crucial for these pediatric cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Emergency Medicine
Background:
- Intussusception is a common cause of bowel obstruction in young children.
- It can be a life-threatening condition requiring prompt medical attention.
Purpose of the Study:
- To investigate if transfer from outside hospitals (OSH) without pediatric tertiary care impacts the need for surgical management of intussusception.
- To identify risk factors associated with surgical intervention for intussusception.
Main Methods:
- Retrospective review of 270 intussusception patients (2009-2014).
- Analysis of patient demographics, symptom duration, and management (radiologic vs. surgical).
- Comparison of outcomes for directly admitted versus transferred patients from OSH.
Main Results:
- 20% of patients required surgery; 63.8% of these were transfers from OSH.
- Transferred patients needing surgery spent significantly longer at OSH (7.77 hours) than those not needing surgery (4.03 hours).
- Time spent at OSH, not transport time, was a significant factor for surgical necessity.
Conclusions:
- Prolonged time at facilities lacking pediatric surgical capabilities is an independent risk factor for surgical management of intussusception.
- Expedited transfer of pediatric intussusception patients from OSH to tertiary centers is recommended.
- Delaying transport after failed enema reduction increases the likelihood of surgery.
Introduction:
Intussusception is a potentially life-threatening condition, and a frequent cause of bowel obstruction during the first two years of life. We hypothesized that patients who were transferred from outside community hospitals, or OSH, without tertiary care capabilities for pediatric services to a large academic children's hospital with intussusception were more likely to require operative management for their intussusception than those who were directly admitted.
Methods:
The electronic medical record was queried for patients presenting to Ann and Robert H. Lurie Children's Hospital of Chicago with a diagnosis of intussusception (July 1st, 2009-July 1st, 2014). Age, sex, symptom duration, radiologic management, and surgical care were recorded. OSH and transfer reports were analyzed for those patients that presented as a transfer. Statistical analysis was performed.
Results:
We identified 270 patients with intussusception. 232 (80%) were successfully treated non-surgically. 58 (20%) required surgical management. Of the patients requiring surgery, there were 38 reductions (24 laparoscopic, 14 open) and 20 bowel resections (1 laparoscopic, 19 open). Of those patients requiring surgery, 37 (63.8%) had presented as a transfer from an OSH. We found that transferred patients, requiring surgery, spent a mean 7.77 hours at the OSH compared to 4.03 hours for the transferred patients that did not require surgery (p=0.0188). There was no significant difference in transport time (p=0.44).
Conclusion:
In conclusion, we identified the amount of time patients spend at hospitals without pediatric surgical capabilities as an independent risk factor necessitating surgical management of intussusception. These data suggest that patients with intussusception who present to hospitals without pediatric radiology or pediatric surgery, should be transferred in an expedited fashion. In the event of a failed enema reduction at an OSH, the transport of the patient should not be delayed as this may result in a higher likelihood of surgical management.
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