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Reduction of intussusception: defining a better index of successful non-operative treatment

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Abstract

The reported non-operative reduction rate for intussusception is usually the proportion of attempted non-operative (radiological) reductions that succeed, which we term the “selective reduction rate.” This value shows wide variation that may result from selection bias that is difficult to quantify because data regarding primary operative treatment are frequently lacking. The proportion of patients with late clinical presentation or pathological lead points can also distort the apparent efficacy of non-operative treatment. We found no definitions of outcome measures in the literature or practice guidelines to inform analysis. Based on analysis of our own audit data we derived a “composite reduction rate” from first principles that can account for variations in radiological and surgical treatment thresholds that might bias other measures of successful non-operative treatment. This index is the proportion of intussusceptions not requiring resection that are successfully reduced non-operatively. We propose that the composite reduction rate be used as a key component of standardised multidisciplinary outcome reporting for intussusception rather than the selective reduction rate. The reduced bias and confounding would allow fairer comparisons and lead to better outcome standards.

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References

  1. Stringer MD, Pledger G, Drake DP (1992) Childhood deaths from intussusception in England and Wales, 1984-9. BMJ 304:737–739

    Article  PubMed  CAS  Google Scholar 

  2. Parashar UD, Holman RC, Cummings KC et al (2000) Trends in intussusception-associated hospitalizations and deaths among US infants. Pediatrics 106:1413–1421

    Article  PubMed  CAS  Google Scholar 

  3. Jen HC, Shew SB (2009) The impact of hospital type and experience on the operative utilization in pediatric intussusception: a nationwide study. J Pediatr Surg 44:241–246

    Article  PubMed  Google Scholar 

  4. Rosenfeld K, McHugh K (1999) Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better. Clin Radiol 54:452–458

    Article  PubMed  CAS  Google Scholar 

  5. Samad L, Marven S, El Bashir H et al (2012) Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 99:411–415

    Article  PubMed  CAS  Google Scholar 

  6. Farr CE (1926) The reduction of colonic intussusception by air inflation. Ann Surg 84:588–590

    PubMed  CAS  Google Scholar 

  7. Ein SH, Palder SB, Alton DJ et al (1994) Intussusception: toward less surgery? J Pediatr Surg 29:433–435

    Article  PubMed  CAS  Google Scholar 

  8. Bai YZ, Qu RB, Wang GD et al (2006) Ultrasound-guided hydrostatic reduction of intussusceptions by saline enema: a review of 5218 cases in 17 years. Am J Surg 192:273–275

    Article  PubMed  Google Scholar 

  9. Sargent MA, Wilson BP (1991) Are hydrostatic and pneumatic methods of intussusception reduction comparable? Pediatr Radiol 21:346–349

    Article  PubMed  CAS  Google Scholar 

  10. Fishman MC, Borden S, Cooper A (1984) The dissection sign of nonreducible ileocolic intussusception. Am J Roentgenol 143:5–8

    Article  CAS  Google Scholar 

  11. McHugh K (2003) Guidelines for intussusception reduction. British Society of Paediatric Radiology draft guidelines for suggested safe practice. London

  12. Curtis JL, Gutierrez IM, Kirk SR et al (2010) Failure of enema reduction for ileocolic intussusception at a referring hospital does not preclude repeat attempts at a children's hospital. J Pediatr Surg 45:1178–1181

    Article  PubMed  Google Scholar 

  13. Takahashi T, Okazaki T, Watayo H et al (2009) Radiographic signs predictive of success of hydrostatic reduction of intussusception. Pediatr Surg Int 25:977–980

    Article  PubMed  Google Scholar 

  14. Cankorkmaz L, Koyluoglu G, Arslan MS et al (2010) Our childhood cases with intussusception and pneumatic reduction. Ulus Travma Acil Cerrahi Derg 16:363–366

    PubMed  Google Scholar 

  15. Gilmore AW, Reed M, Tenenbein M (2011) Management of childhood intussusception after reduction by enema. Am J Emerg Med 29:1136–1140

    Article  PubMed  Google Scholar 

  16. Niramis R, Watanatittan S, Kruatrachue A et al (2010) Management of recurrent intussusception: nonoperative or operative reduction? J Pediatr Surg 45:2175–2180

    Article  PubMed  Google Scholar 

  17. Chen SC, Wang JD, Hsu HY et al (2010) Epidemiology of childhood intussusception and determinants of recurrence and operation: analysis of national health insurance data between 1998 and 2007 in Taiwan. Pediatr Neonatol 51:285–291

    Article  PubMed  Google Scholar 

  18. Kodikara H, Lynch A, Morreau P et al (2010) Ten-year review of intussusception at Starship Hospital: 1998–2007. N Z Med J 123:32–40

    PubMed  Google Scholar 

  19. Ramachandran P, Gupta A, Vincent P et al (2008) Air enema for intussusception: is predicting the outcome important? Pediatr Surg Int 24:311–313

    Article  PubMed  CAS  Google Scholar 

  20. Saxena AK, Hollwarth ME (2007) Factors influencing management and comparison of outcomes in paediatric intussusceptions. Acta Paediatr 96:1199–1202

    Article  PubMed  CAS  Google Scholar 

  21. Whitehouse JS, Gourlay DM, Winthrop AL et al (2010) Is it safe to discharge intussusception patients after successful hydrostatic reduction? J Pediatr Surg 45:1182–1186

    Article  PubMed  Google Scholar 

  22. Shekherdimian S, Lee SL, Sydorak RM et al (2009) Contrast enema for pediatric intussusception: is reflux into the terminal ileum necessary for complete reduction? J Pediatr Surg 44:247–249, discussion 249–250

    Article  PubMed  Google Scholar 

  23. Okazaki T, Ogasawara Y, Nakazawa N et al (2006) Reduction of intussusception in infants by a pediatric surgical team: improvement in safety and outcome. Pediatr Surg Int 22:897–900

    Article  PubMed  Google Scholar 

  24. Lehnert T, Sorge I, Till H et al (2009) Intussusception in children—clinical presentation, diagnosis and management. Int J Colorectal Dis 24:1187–1192

    Article  PubMed  Google Scholar 

  25. Shapkina AN, Shapkin VV, Nelubov IV et al (2006) Intussusception in children: 11-year experience in Vladivostok. Pediatr Surg Int 22:901–904

    Article  PubMed  CAS  Google Scholar 

  26. Fragoso AC, Campos M, Tavares C et al (2007) Pneumatic reduction of childhood intussusception. Is prediction of failure important? J Pediatr Surg 42:1504–1508

    Article  PubMed  Google Scholar 

  27. Kaiser AD, Applegate KE, Ladd AP (2007) Current success in the treatment of intussusception in children. Surgery 142:469–475, discussion 475–477

    Article  PubMed  Google Scholar 

  28. Blanch AJ, Perel SB, Acworth JP (2007) Paediatric intussusception: epidemiology and outcome. Emerg Med Australas 19:45–50

    Article  PubMed  Google Scholar 

  29. Jo DS, Nyambat B, Kim JS et al (2009) Population-based incidence and burden of childhood intussusception in Jeonbuk Province, South Korea. Int J Infect Dis 13:e383–e388

    Article  PubMed  Google Scholar 

  30. Navarro OM, Daneman A, Chae A (2004) Intussusception: the use of delayed, repeated reduction attempts and the management of intussusceptions due to pathologic lead points in pediatric patients. Am J Roentgenol 182:1169–1176

    Article  Google Scholar 

  31. Justice FA, Auldist AW, Bines JE (2006) Intussusception: trends in clinical presentation and management. J Gastroenterol Hepatol 21:842–846

    Article  PubMed  Google Scholar 

  32. Lui KW, Wong HF, Cheung YC et al (2001) Air enema for diagnosis and reduction of intussusception in children: clinical experience and fluoroscopy time correlation. J Pediatr Surg 36:479–481

    Article  PubMed  CAS  Google Scholar 

  33. Hadidi AT, El Shal N (1999) Childhood intussusception: a comparative study of nonsurgical management. J Pediatr Surg 34:304–307

    Article  PubMed  CAS  Google Scholar 

  34. Bratton SL, Haberkern CM, Waldhausen JH et al (2001) Intussusception: hospital size and risk of surgery. Pediatrics 107:299–303

    Article  PubMed  CAS  Google Scholar 

  35. Gu L, Alton DJ, Daneman A et al (1988) John Caffey Award. Intussusception reduction in children by rectal insufflation of air. Am J Roentgenol 150:1345–1348

    Article  CAS  Google Scholar 

  36. Daneman A, Alton DJ, Lobo E et al (1998) Patterns of recurrence of intussusception in children: a 17-year review. Pediatr Radiol 28:913–919

    Article  PubMed  CAS  Google Scholar 

  37. Chaudry G, Navarro OM, Levine DS et al (2006) Abdominal manifestations of cystic fibrosis in children. Pediatr Radiol 36:233–240

    Article  PubMed  Google Scholar 

  38. Britton I, Wilkinson AG (1999) Ultrasound features of intussusception predicting outcome of air enema. Pediatr Radiol 29:705–710

    Article  PubMed  CAS  Google Scholar 

  39. Stephenson CA, Seibert JJ, Strain JD et al (1989) Intussusception: clinical and radiographic factors influencing reducibility. Pediatr Radiol 20:57–60

    Article  PubMed  CAS  Google Scholar 

  40. Pierro A, Donnell SC, Paraskevopoulou C et al (1993) Indications for laparotomy after hydrostatic reduction for intussusception. J Pediatr Surg 28:1154–1157

    Article  PubMed  CAS  Google Scholar 

  41. Jewell FM, Roobottom C, Duncan A (1995) Variations in the radiological management of intussusception: results of a postal survey. Br J Radiol 68:13–18

    Article  PubMed  CAS  Google Scholar 

  42. Saxton V, Katz M, Phelan E et al (1994) Intussusception: a repeat delayed gas enema increases the nonoperative reduction rate. J Pediatr Surg 29:588–589

    Article  PubMed  CAS  Google Scholar 

  43. Applegate KE (2009) Intussusception in children: evidence-based diagnosis and treatment. Pediatr Radiol 39(Suppl 2):S140–S143

    Article  PubMed  Google Scholar 

  44. Murakami JW, Winters WD, Weinberger E et al (1998) Extensive reflux of air during enema for intussusception without reduction: case report. Can Assoc Radiol J 49:334–335

    PubMed  CAS  Google Scholar 

  45. Koplewitz BZ, Simanovsky N, Lebensart PD et al (2011) Air encircling the intussusceptum on air enema for intussusception reduction: an indication for surgery? Br J Radiol 84:719–726

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Paediatric Surgery Unit, Sheffield Children’s Hospital, Western Bank, Sheffield, S10 2TH, UK

    Basil Bekdash & Sean S. Marven

  2. Department of Radiology, Sheffield Children’s Hospital, Western Bank, Sheffield, UK

    Alan Sprigg

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  1. Basil Bekdash
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  2. Sean S. Marven
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  3. Alan Sprigg
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Correspondence to Basil Bekdash.

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Bekdash, B., Marven, S.S. & Sprigg, A. Reduction of intussusception: defining a better index of successful non-operative treatment. Pediatr Radiol 43, 649–656 (2013). https://doi.org/10.1007/s00247-012-2552-6

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  • DOI: https://doi.org/10.1007/s00247-012-2552-6

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