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Diagnosis and treatment of childhood intussusception from 1997 to 2016: A population-based study
Mila Kolar1, Mercedes Pilkington1, Andrea Winthrop1
1Department of Surgery, Queen's University, Kingston Health Sciences Centre, 76 Stuart St., Kingston, ON, Canada K7L 2V7.
Insights
Pediatric intussusception management shifted to nonoperative reduction with universal pretreatment imaging over two decades. Surgical rates remain higher in community hospitals compared to tertiary centers.
Area of Science:
- Pediatric gastroenterology and surgery
- Healthcare quality improvement
- Public health research
Background:
- Intussusception is a common pediatric surgical emergency.
- Treatment approaches have evolved, necessitating an analysis of trends.
- Understanding diagnostic and treatment patterns is crucial for optimizing care.
Purpose of the Study:
- To describe changes in the diagnostic approach and treatment modalities for pediatric intussusception over a 20-year period.
- To analyze trends in imaging use and nonoperative versus surgical management.
- To compare treatment patterns between community and tertiary care centers.
Main Methods:
- Population-based cohort study using administrative healthcare data from Ontario, Canada (1997-2016).
- Inclusion of all pediatric patients (<18 years) treated for intussusception.
- Determination of treatment modality (nonoperative, surgical, failed nonoperative) via linked databases and trend analysis using statistical methods.
Main Results:
- Pretreatment imaging use increased significantly from 57.5% to 99.3%.
- Nonoperative management rose from 23.4% to 75.2% of cases.
- Surgical intervention rates were higher in community (43%) versus tertiary (11%) centers, with increasing bowel resections over time.
Conclusions:
- Universal pretreatment imaging and a shift towards nonoperative management characterize pediatric intussusception care over two decades.
- Disparities in surgical intervention rates persist between community and tertiary care settings.
- Continued evaluation of care patterns is essential for improving pediatric intussusception outcomes.
Objectives:
Describe changes in the diagnostic approach and treatment for pediatric intussusception over two decades.
Study Design:
Administrative universal healthcare data were used to conduct a population-based cohort study of intussusception between January 1997 and December 2016 in Ontario, Canada. A validated case definition was used to identify all patients (<18 years) treated for intussusception in the province at community or tertiary care centers. Treatment modality was determined using physician billing data and databases linked at ICES; it was categorized as nonoperative alone, surgical alone, or failed nonoperative. Descriptive statistics, Cochrane-Armitage for trend analyses, and graphical and multinomial logistic regression were performed.
Results:
Over 20 years, 1895 pediatric patients were treated for intussusception. Pretreatment imaging use rose from 57.5% to 99.3%. Nonoperative management increased from 23.4% to 75.2%. However, 43% of children who presented to a community hospital underwent immediate surgical management, compared with just 11% of children at tertiary centers (RR 0.39, 95% CI: 0.25-0.62). Among children who underwent surgery, there was an increase in bowel resection over time (41.7% to 57.6%).
Conclusions:
Over the 20 year period of study, pretreatment imaging became universal, and management shifted from predominantly surgical to nonoperative reduction in Ontario. The rate of surgical intervention remains higher in community versus tertiary centers.
Level Of Evidence:
Treatment study, III.
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