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Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients.
Mertiri, Livja; Sher, Andrew C; Sammer, Marla B; Ngan, Esther; Seghers, Victor J; Madueke, U Michael; Stafford, Shawn; Kraus, Steven J; Kan, J Herman.
Afiliación
  • Mertiri L; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
  • Sher AC; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
  • Sammer MB; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
  • Ngan E; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
  • Seghers VJ; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
  • Madueke UM; Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA.
  • Stafford S; Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
  • Kraus SJ; Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA.
  • Kan JH; Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, Suite 470, TX 77030, USA.
AJR Am J Roentgenol ; 2024 Sep 04.
Article en En | MEDLINE | ID: mdl-39230408
ABSTRACT

BACKGROUND:

Radiologists generally treat pediatric ileocolic intussusceptions emergently given potential worse outcomes from delayed reduction attempts. However, relevant literature is conflicting.

OBJECTIVE:

To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention to the time interval since diagnosis.

METHODS:

This retrospective study included patients <6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups those presenting directly to the institution (nontransferred patients, who all underwent attempted reduction <8 hours after ultrasound diagnosis), and those transferred from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed.

RESULTS:

The study included 1065 patients (649 male, 416 female; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). In nontransferred patients, the mean interval between ultrasound diagnosis and reduction attempt was 150.8 minutes; in transferred patients, the mean interval between outside facility advanced imaging and reduction attempt was 460.1 minutes (p<.001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p=.25). In nontransferred patients, success occurred in 85.6% of attempts <2 hours after diagnosis versus 84.0% of attempts 2-<8 hours after diagnosis (p=.54); the mean interval from diagnosis to attempted reduction was 149.7 minutes and 156.8 minutes for successful and unsuccessful attempts, respectively (p=.53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR=3.63, p<.001) and absence of high-risk ultrasound findings (OR=2.57, p<.001); success was not independently associated with age, sex, bloody stools, reduction method, or time since diagnosis <2 hours (p>.05). In transferred patients, the mean interval from outside advanced imaging to attempted reduction was 463.1 minutes and 440.2 minutes for successful and unsuccessful attempts, respectively (p=.74).

CONCLUSION:

Intussusception reduction may not require completion emergently (within 2 hours after diagnosis), but potentially may be safely performed on an urgent basis (within 8 hours). CLINICAL IMPACT The findings have implications for determining the standard of care, including criteria for oncall activation of radiologic resources, in pediatric intussusception management.

Texto completo: 1 Banco de datos: MEDLINE Idioma: En Revista: AJR Am J Roentgenol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Banco de datos: MEDLINE Idioma: En Revista: AJR Am J Roentgenol Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos