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Discharge Strategies Following Successful Ileocolic Intussusception Reduction: Hospitalization vs Emergency
Daniel M Cohen1, Sara Helwig1, Naveen Poonai2
1Department of Pediatrics, The Ohio State University and Nationwide Children's, Columbus, OH.
Insights
Discharging children from the emergency department after ileocolic intussusception reduction may increase return visits. However, both emergency department discharge and inpatient hospitalization show high success rates for recurrent intussusception re-reduction.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
- Surgical Outcomes
Background:
- Ileocolic intussusception (ICI) is a common pediatric surgical emergency.
- Successful reduction of intussusception can be followed by different discharge strategies.
- Comparing inpatient hospitalization versus emergency department (ED) observation/discharge is crucial for optimizing care.
Purpose of the Study:
- To compare the effectiveness and safety of two discharge strategies after successful ileocolic intussusception reduction.
- To evaluate the rates of recurrent intussusception (re-ICI) and return to the ED based on discharge disposition.
- To inform clinical decision-making regarding hospitalization versus ED discharge for children with ICI.
Main Methods:
- A planned secondary analysis of a large international cohort of children (4 months to 4 years) with successful ICI reduction.
- Data collected from 86 pediatric centers across 14 countries (2017-2019).
- Evaluation of associations between discharge strategy (inpatient vs. ED discharge) and outcomes like ED return for re-ICI within 48 hours and the study period.
Main Results:
- 2,686 ICI cases analyzed; 59% hospitalized, 41% discharged from ED.
- Overall ED return for ICI was 8.9%; 10.2% of ED-discharged patients returned vs. 7.9% of hospitalized patients.
- Patients discharged from the ED had a significantly higher odds of return within 48 hours (aOR=3.43) and within the study period (aOR=1.48) compared to hospitalized patients.
- Re-reduction success rates were high and comparable in both groups (83.9%–94.1%).
Conclusions:
- While ED discharge after successful ICI reduction may be associated with a higher risk of return visits for recurrent intussusception, the rates of successful re-reduction remain high.
- The findings suggest that individualized assessment of risks and benefits is essential.
- Clinicians should consider patient-specific factors to potentially avoid unnecessary hospitalizations while ensuring safety.
Objective:
To compare discharge strategies following successful ileocolic intussusception (ICI) reduction: inpatient hospitalization vs emergency department (ED) observation/discharge.
Study Design:
This was a planned secondary analysis of children ages 4 months to 4 years with successful ICI from 86 pediatric centers in 14 countries between January 1, 2017 and December 31, 2019. We evaluated associations between discharge strategy for outpatient recurrent ICI (re-ICI). The primary outcome was ED return for re-ICI <48 hours and the secondary within the study period.
Results:
We analyzed 2686 cases of ICI; 1588 (59%) admitted to hospital and 1098 (41%) discharged from ED with median (IQR) age of 18 (9, 28) months. During the study period 238 (8.9%) returned to the ED for ICI; 10.2% (112/1098) were discharged from the ED and 7.9% (126/1588) after inpatient hospitalization. Among these 238 patients, 66 (2.5%) returned <48 h most of whom had been discharged directly from the ED with a higher odds of a return visit <48 hours compared with those admitted (odds ratio [OR] = 4.27, CI = 2.50, 7.68; adjusted OR = 3.43, CI = 1.72, 7.29), and increased odds of returning within the study period (OR = 1.32, 95% CI 1.01, 1.72; adjusted OR = 1.48, 95% CI 1.03, 2.13). Upon return, the ICI re-reduction success rate was equally high in each group, ranging from 83.9% to 94.1%.
Conclusions:
Few children return to the ED with outpatient recurrent ICI, following successful reduction. Although the odds of return <48 hours due to re-ICI appear higher among patients discharged from the ED vs hospitalized, both groups have equally high rates of successful re-reduction. These findings suggest that clinicians should holistically weigh the risks and benefits, taking individual circumstances into account, to help reduce unnecessary hospitalizations.
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