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Management of Intussusception in the Pediatric Emergency Department: Risk Factors for Recurrence
Andrea Vo1, Terry L Levin2, Benjamin Taragin2
1From the Departments of Pediatrics.
Pediatric Emergency Care
|December 13, 2017
Summary
Early recurrence of intussusception after air reduction enema (ARE) is uncommon. Girls and children with fever are at higher risk, suggesting potential for earlier discharge in select cases.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Radiology
Background:
- Standard intussusception treatment involves air reduction enema (ARE) followed by 24-48 hours of inpatient observation.
- Emerging evidence suggests shorter observation periods (4-6 hours) may be safe for some patients post-ARE.
- Identifying risk factors for recurrence and ARE failure is crucial for optimizing patient management.
Purpose of the Study:
- To identify risk factors associated with early recurrence of intussusception after successful ARE.
- To validate existing risk criteria for early recurrence.
- To identify predictors of ARE failure.
Main Methods:
- Retrospective cohort study of children diagnosed with intussusception or undergoing ARE between 2005-2015.
- Data collection included demographics, radiology, and clinical course.
- Exclusion criteria: repeat visits, incomplete records, incorrect diagnoses.
Main Results:
- 163 patients had successful ARE; 22 (13.5%) recurred, with 12 (7.3%) within 48 hours.
- Fever (OR 4.25) and female sex (OR 7.94) were independently associated with early recurrence.
- No radiologic features correlated with early recurrence.
Conclusions:
- Early recurrence after successful ARE is infrequent but more common in girls and those with fever (>100.4°F).
- These findings support further prospective research to validate risk criteria for early discharge.
- Identifying low-risk patients could enable emergency department discharge, optimizing resource utilization.
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