Radiographic and Clinical Factors in Pediatric Patients With Surgical Small-bowel Intussusception.

BACKGROUND: When evaluating a pediatric patient with abdominal pain, identification of a small bowel-to-small bowel intussusception (SBI) on radiologic imaging can create a diagnostic dilemma. The clinical significance and need for surgical exploration of SBI is highly variable, as most of them are considered clinically insignificant. We hypothesize that combination of clinical and radiologic factors in an exclusively SBI population will yield factors that guide the clinician in making operative decisions. METHODS: A comprehensive database from a pediatric tertiary hospital was reviewed from January 1, 2011, to December 31, 2016, for any radiographic study mentioning intussusception. Results were reviewed for patients having only SBI (i.e., not ileocolic intussusception), and this comprised the study cohort. The electronic medical records for these patients were reviewed for clinical presentation variables, need for operative intervention, and identification of the intussusception during surgery. Patients with SBI due to enteral feeding tubes were excluded from the study. RESULTS: Within the study period, 139 patients were identified with an SBI on radiologic imaging. Univariate analysis yielded numerous clinical and radiologic factors highly predictive of the need for surgical intervention. However, upon multivariate analysis, only a history of prior abdominal surgery (odds ratio [OR]: 7.2; CI: 1.1-46.3), the presence of focal abdominal pain (OR: 22.1; CI: 4.2-116.3), and the intussusception length (cm; OR: 10.6; CI: 10.3-10.8) were correlated with the need for surgical intervention. CONCLUSIONS: SBI is a disease process with a highly variable clinical significance. The presence of focal abdominal pain, a history of prior abdominal surgery, and the intussusception length are the greatest predictors of the need for operative intervention. LEVEL OF EVIDENCE: Level II.

Clinical Impact of a Radiologic Quality Initiative Promoting More Timely Communication of Critical Pulmonary Embolus Results.

BACKGROUND: A section quality initiative was implemented beginning 2013 requiring positive pulmonary embolism (PE) results to be documented and communicated within 90 minutes of exam completion. The objective of this study is to evaluate the effect of this quality initiative on different intervals comprising the total patient processing time, namely the time from when the imaging exam was ordered to study completion interval, the time from study completion to positive PE result communication (TAT interval) or treatment initiation (TTT interval), the time from result communication to treatment initiation (TRCTI interval), and the total patient processing time (TPT interval). METHODS: This was a retrospective, single-institution, IRB-approved cohort study that included 830 patients with the diagnosis of acute PE confirmed by CT pulmonary angiography. A maximum of 10 positive exams per month were identified and analyzed over an 84-month period from January 2010 to December 2016. The following data were obtained: time when exam ordered, time of imaging study completion, time of report completion, time of result communication, time of treatment, type of treatment, and reasons for any treatment delay. Analysis was done by determining the mean time spent in various intervals, the cumulative relative frequency of interval completion, and the fraction of the entire patient processing time spent in each interval. RESULTS: Mean analysis demonstrated a decrease in all time intervals in the postpolicy period (ordered to study completion: Δ24.50%, p = 0.004; TAT: Δ23.91%, p < 0.001; TRCTI: Δ16.86%, p = 0.031; TTT: Δ17.40%, p = 0.005; TPT: Δ15.94%, p = 0.002). Cumulative relative frequency analysis demonstrated a higher rate of interval completion in the postpolicy period (TAT: p < 0.001; TRCTI: p = 0.007; TPT: p = 0.025). Interval fraction analysis demonstrated changes in the fraction of processing time spent in varying intervals (TAT: -Δ14.42%, p = 0.002; TRCTI: +Δ17.65%, p = 0.001). CONCLUSION: Total patient processing time decreased after the policy implementation with a more significant decrease in TAT compared to other intervals. Radiologic processing time does not appear to be the rate-limiting step in total patient processing time.