Y. Puckett1, J. Greenspon1, C. Fitzpatrick1, D. Vane1, S. Bansal1, M. Rice1, K. Chatoorgoon1 1Saint Louis University School Of Medicine,Pediatric Surgery,St. Louis, MO, USA
Introduction: The standard practice in pediatric patients diagnosed with intussusception radiographically has been reduction via enema and admission for a period of nil per os and observation. However, little data exists that supports this practice. With the recent heavy emphasis on effective medical resource allocation, it is possible that this practice may be potentially eliminable. The objective of this study was to conduct a retrospective review for recurrence rates after enema reduction in children while in hospital, to examine the cost that is incurred by admission, and to examine whether post-reduction admission to hospital is necessary.
Methods: A retrospective chart review was performed on all patients aged 0-4 years old diagnosed with intussusception based on ICD-9 codes over the last twenty years at a single center pediatric hospital. Study included children 0-4 years of age who were treated for intussusception on first encounter with air contrast or barium enema that were subsequently admitted to the hospital for observation. Study excluded patients older than 4 years of age, those who were readmitted for recurrence after 48 hours, patients whose intussusception did not successfully reduce with enema on first try, and those who went to the operating room because of peritonitis on exam or perforation on enema. Early recurrence was defined as recurrence within 48 hours post-reduction.
Results: A total of 171 patients out of 272 met inclusion criteria. Out of 171 patients who were admitted to the hospital for observation post-reduction, only one experienced an early recurrence (0.6%). The median length of stay for all patients was 2 days with an interquartile range of 1-2. The average cost incurred per day for intussusception admission was determined to be $404.00 at our hospital.
Conclusion: Intussusception in a child that is successfully reduced via enema has a low rate of recurrence and is usually followed by prompt resolution of symptoms. An abbreviated period of observation in the emergency department post intussusception reduction may result in costs savings of approximately $808/patient.