Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction

McLeod, Jennifer S.; Gavulic, Amelia E.; Wendt, Wendi Jo; Hilu, Matthew H.; Dunbar, Erin E.; Macy, Michelle L.; Sroufe, Nicole S.; Perrone, Erin E.

doi:10.1016/j.jss.2019.06.036

Cited by 5 publications

(7 citation statements)

References 17 publications

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“…Intussusception, which requires efficient interdepartmental cooperation and a timely POCUS examination, is a good candidate for CP application in the pediatric ED. However, few previous studies have examined the impact of CP on intussusception outcomes; in fact, previous studies have mainly focused on treatments or postreduction care [12,13] . The present study is unique in that it outlines all steps involved in intussusception management (from diagnosis to hospitalization) and treatment, depending on intussusception type.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[10,11] Although intussusception is a time-sensitive disease in pediatric EDs, few previous studies have examined the role of CPs in its diagnosis and treatment, focusing primarily on management. [12,13] In January 2017, we introduced a quality improvement project at our pediatric ED for rapid identification, and effective and efficient management of intussusception. We compared the outcomes of patients with intussusception before and after the implementation of CPs at our pediatric ED.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of the implementation of pediatric intussusception clinical pathway

et al. 2021

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Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED. In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes. A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% ( P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure. The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of the implementation of pediatric intussusception clinical pathway

et al. 2021

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“…Acute intussusception is one of the most common acute abdominal emergencies in infancy and childhood. 1 Clinical manifestations are paroxysmal abdominal pain, crying, vomiting, dark red-currant jelly stool, and a palpable sausage-like, slightly active, and tender mass in the abdomen. [2][3][4][5][6] Primary intussusception accounts for about 90%.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception

et al. 2021

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Objective This study aims to explore the effectiveness and safety of the new-type ultrasound-guided hydrostatic reduction for children with acute intussusception. Methods The clinical data of 364 children with primary acute intussusception who underwent nonsurgical reduction in our hospital between January 2016 and May 2019 were retrospectively analyzed. Among the 364 children, 119 formed the hydrostatic reduction group. There were 89 males and 30 females, and the average age of admission was 25.13 ± 1.43 months. Among the pneumatic reduction group of 245 patients, there were 163 males and 82 females. The average age of admission was 22.47 ± 1.52 months. The reduction rate, length of stay, and perforation rate were compared between the two groups. Results Univariate analysis showed that the reduction rate in the hydrostatic group (94.96%) was higher than in the pneumatic group (85.31%) ( p = 0.007), and the hospital stay (2.76 ± 0.15 days) of the hydrostatic reduction group was shorter than that of the pneumatic reduction group (3.56 ± 0.35 days) ( p = 0.038). In children with intussusception time >48 h, the reduction rate was 95.45% in the hydrostatic reduction group and 86.20% in the pneumatic reduction group. Conclusion The new-type ultrasound-guided hydrostatic reduction has a higher reduction rate in the treatment of acute intussusception in children results in a shortened hospital stay, It is effective, safe, and avoids radiation exposure.

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“…8 Recent studies have suggested that the current management of admitting patients with ICI for the observation after successful enema reduction may be unnecessary. 9,10 Nevertheless, the traditional practice of admission for an observation period of 24 to 48 hours persists today in many centers, justified mainly by the theoretical risk of early recurrence in the first hours after enema reduction. 11,12 Several studies have analyzed different risk factors for early recurrence such as age, duration of symptoms, bloody stools, and even oral tolerance and early discharge.…”

Section: Introductionmentioning

confidence: 99%

Routine Ultrasound Control after Successful Intussusception Reduction in Children: Is It Really Necessary?

et al. 2020

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Introduction Recurrence of ileocolic intussusception (ICI) has been related to residual bowel wall edema after enema reduction. Early oral tolerance has been associated with a higher risk of re-intussusception, so an imaging test (ultrasound) has traditionally been performed before restarting oral tolerance. Our aim is to analyze the cost-effectiveness of performing a routine ultrasound in patients who remain asymptomatic after successful enema reduction. Materials and Methods A retrospective observational study was performed in patients with ICI who underwent a successful enema reduction between 2005 and 2019 and distributed in two groups according to whether or not a routine ultrasound was performed before restarting oral tolerance: group A (ultrasound) or B (no ultrasound). We analyzed demographic, clinical and laboratory variables, length of hospital stay, and recurrence rate. Results We included 366 patients who presented 373 ICI episodes (165 in group A and 208 in group B), without significant differences in gender and age. Group A patients presented a higher percentage of vomiting and bloody stools than those in group B without differences in the other clinical features studied, time of evolution, or laboratory variables. Group A presented a higher length of hospital stay than group B (36 vs. 24 hours), although it was not statistically significant (p = 0.30). No statistically significant differences were observed in the recurrence rate between both groups (10.3% A vs. 10.8% B; p = 0.83). Conclusion Performing routine ultrasound before restarting oral tolerance in asymptomatic patients after successful ICI reduction does not decrease the risk of re-intussusception and should not be routinely encouraged.

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Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction

Cited by 5 publications

References 17 publications

Effectiveness of the implementation of pediatric intussusception clinical pathway

Effectiveness of the implementation of pediatric intussusception clinical pathway

Effectiveness and safety of ultrasound-guided hydrostatic reduction for children with acute intussusception

Routine Ultrasound Control after Successful Intussusception Reduction in Children: Is It Really Necessary?

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