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[Intestinal invagination in children in the county of Hordaland 1983-92]
1Det medisinske fakultet, Universitetet i Bergen.
Insights
Pediatrician referrals improved diagnostic accuracy for intussusception but did not alter patient outcomes. This suggests general practitioners effectively recognized the urgency of symptoms in children.
Area of Science:
- Pediatric gastroenterology
- Epidemiology of childhood diseases
Background:
- Intussusception is a significant cause of bowel obstruction in infants and children.
- Understanding referral patterns and their impact on diagnosis and outcomes is crucial for pediatric care.
Purpose of the Study:
- To compare the incidence of intussusception in urban versus rural settings.
- To evaluate the impact of primary care physician type (pediatrician vs. general practitioner) on diagnostic accuracy and patient outcomes.
Main Methods:
- Retrospective analysis of hospital medical records for children aged 0-14 years diagnosed with intussusception between 1983-1992.
- Comparison of incidence rates and clinical data based on geographic location and admitting physician specialty.
Main Results:
- Intussusception incidence was similar in Bergen (1.8/1,000) and surrounding municipalities (1.4/1,000).
- Children referred by pediatricians had higher rates of correct initial diagnosis (70% vs. 42%).
- No significant differences were observed in median age, symptom duration, or need for surgery between groups.
Conclusions:
- Geographic location did not significantly impact intussusception incidence, suggesting spontaneous resolution is rare.
- While pediatricians improved initial diagnostic accuracy, outcomes were comparable to those referred by general practitioners, indicating effective symptom recognition by all primary care providers.
Abstract:
The incidence of intussusception was examined with respect to whether children lived in the city of Bergen, where pediatricians were the primary contacts in 45% of the cases, or in the remaining municipalities where pediatricians were the primary contacts in 18%. Diagnosis and course of illness were compared for children admitted by pediatricians and general practitioners. Information was retrieved from hospital medical records. During 1983-92, 142 children 0 to 14 years were given the diagnosis on basis of barium enema (139 children) or surgery (three children). The incidence was 1.8 per 1,000 children per year for Bergen vs. 1.4 in the rest of the county (p = 0.3). Children admitted by pediatricians more often had the correct referral diagnosis (70% vs. 42%, p = 0.003), but they did not differ with respect to median age (8 months for both), median duration of symptoms (12 vs. 24 hours), percent in need of surgery (58% vs. 59%) or in symptoms. The lack of difference in incidence between Bergen and the more distant municipalities suggests that spontanous resolution of intussusception is uncommon. Although pediatricians more often admitted the children with the correct diagnosis, duration of symptoms and outcome did not differ from those admitted by general practitioners. This suggests that the general practitioners also appreciated the urgency of the symptoms.