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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.
Insights
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.
Background:
The standard treatment for intussusception is air reduction enema (ARE) with inpatient observation for 24 to 48 hours to monitor for recurrence. More recent but limited observations suggest that patients who have undergone successful ARE can safely be discharged after 4 to 6 hours of observation. Our primary objective was to identify risk factors associated with early recurrence. Our secondary objectives included validating risk criteria from prior studies and identifying risk factors for ARE failures.
Design/Methods:
A retrospective cohort study of children discharged from a large urban quaternary hospital with a final diagnosis of intussusception (International Classification of Diseases, Ninth Revision, code 560.0) or who underwent ARE from 2005 to 2015 was identified. Demographic data, radiology images, and clinical course were recorded. Repeat visits, cases with incomplete medical records, and those with incorrect diagnoses were excluded.
Results:
A total of 250 cases were identified. Two hundred cases were included for analysis. Fifty were excluded. Of the 163 who had successful reduction with ARE, 22 patients (13.5%) recurred, and 12 (7.3%) recurred within 48 hours. Fever (odds ratio, 4.25; P = 0.04; 95% confidence interval, 1.04-17.3) and female sex (odds ratio, 7.94; P = 0.01; 95% confidence interval, 1.82-34.6) were independently associated with early recurrence. No radiologic features were associated with early recurrence.
Conclusions:
Early recurrence after successful ARE was low, although more frequent in girls and in those with fever over 100.4°F. We therefore advocate for prospective studies to validate these risk criteria to identify patients who are at low risk for early recurrence and may qualify for early discharge from the emergency department.
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