Bedside Intussusception Diagnosis and Reduction: A Comprehensive Emergency Department Process for Bedside
Nitzan Atia1, Jordanna H Koppel1, Tami Brutman-Barazani2
1Department of Pediatric Emergency Medicine, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel Hashomer, Ramat Gan, Israel.
Insights
A new bedside approach for ileocolic intussusception in the pediatric emergency department (PED) showed high success rates for diagnosis and reduction using ultrasound-guided hydrostatic enema with sedation. This method improved patient care and safety.
Area of Science:
- Pediatric Emergency Medicine
- Pediatric Radiology
- Gastrointestinal Disorders
Background:
- Ileocolic intussusception is a common cause of intestinal obstruction in young children.
- Current diagnosis via ultrasound and treatment with enema often occur outside the pediatric emergency department (PED), lacking adequate sedation.
- This necessitates a more integrated and patient-centered approach within the PED.
Purpose of the Study:
- To evaluate the efficacy and safety of a comprehensive bedside approach for diagnosing and reducing ileocolic intussusception.
- To assess the feasibility of performing ultrasound-guided hydrostatic reduction within the PED.
- To determine the impact of this approach on patient outcomes and resource utilization.
Main Methods:
- A retrospective cohort study of children diagnosed with ileocolic intussusception between January 2021 and July 2024.
- Point-of-care ultrasound for diagnosis and ultrasound-guided hydrostatic reduction performed bedside by pediatric radiologists.
- Sedation administered by pediatric emergency medicine physicians.
Main Results:
- Twenty-eight children underwent bedside diagnosis and reduction.
- An 86% success rate for bedside reduction was achieved, with an average time from admission to reduction of 126 minutes.
- No adverse events were reported, though 7% experienced early recurrence within 48 hours.
Conclusions:
- A comprehensive bedside approach for ileocolic intussusception in the PED is effective and safe.
- This integrated model enhances sedation/analgesia administration and reduces interdepartmental transfers.
- Further prospective studies are warranted to validate these findings.
Objectives:
Ileocolic intussusception is a major cause of intestinal obstruction in children under 2 years of age. Diagnosis is typically confirmed using ultrasonography, and treatment often involves an air or hydrostatic enema performed by radiologists or surgeons outside of the pediatric emergency department (PED) without the provision of adequate sedation or analgesia. This study aimed to assess the efficacy and safety of a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception within the PED of a tertiary care pediatric hospital.
Methods:
A retrospective cohort study conducted between January 2021 and July 2024. Key outcome variables included the reduction success rate, time to reduction, and adverse events.
Results:
During the study period, 28 children diagnosed with ileocolic intussusception via point-of-care ultrasound were treated bedside with ultrasound-guided hydrostatic reduction performed by a pediatric radiologist under sedation provided by pediatric emergency medicine physicians. There were 20 (86%) successful bedside reductions with an average time from admission to reduction of 126 minutes and an average length of stay of 407 minutes, respectively. No adverse events were recorded, although early recurrence of intussusception within 48 hours occurred in 2 patients (7%).
Conclusion:
This is the first study that detailed a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception in the PED. This approach has a high success rate, minimizes the need for interdepartmental transfers, and facilitates the administration of appropriate sedation and analgesia without significant adverse events. Further prospective studies are needed to confirm the safety and efficacy of this bedside approach.
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