Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging
• Clinical Pathway Implementation

Background:

• Intussusception is a common pediatric emergency associated with acute abdomen.
• Delays in diagnosis and treatment of intussusception pose significant challenges in pediatric emergency departments (EDs).

Purpose of the Study:

• To evaluate the impact of implementing intussusception clinical pathways (CPs), incorporating bedside point-of-care ultrasonography, on patient management within a pediatric ED.
• To assess changes in diagnostic and treatment times, ED length of stay, and patient outcomes following CP implementation.

Main Methods:

• A retrospective study comparing patient outcomes before (January 2015-December 2016) and after (January 2017-January 2019) the implementation of an intussusception management protocol.
• Analysis included 106 patients in the preprotocol group and 108 in the postprotocol group, focusing on door-to-ultrasonography time, door-to-reduction time, ED length of stay, and admission rates.

Main Results:

• Median door-to-ultrasonography time decreased from 66.5 to 54 minutes.
• Median door-to-reduction time decreased from 121.5 to 80.5 minutes.
• Median ED length of stay reduced from 440 to 303.5 minutes, with an increased admission rate from 18.9% to 40.7% (P < .01). No significant differences were observed in complication rates, readmissions, emergency surgeries, or reduction failures.

Conclusions:

• Intussusception CPs, especially when utilizing point-of-care ultrasonography, effectively decrease time-to-diagnosis and time-to-treatment in pediatric EDs.
• The implementation of these CPs enhances the efficiency of time and resource utilization in managing pediatric intussusception.