Is it safe to discharge intussusception patients after successful hydrostatic reduction?

• Published in: Journal of pediatric surgery Vol. 45; no. 6; pp. 1182 - 1186
• Main Authors: Whitehouse, Jill S, Gourlay, David M, Winthrop, Andrea L, Cassidy, Laura D, Arca, Marjorie J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2010
• Subjects: Adolescent; Child; Child, Preschool; Emergency department discharge; Follow-Up Studies; Humans; Hydrostatic Pressure; Hydrostatic reduction; Infant; Infant, Newborn; Intussusception; Intussusception - therapy; Nonoperative management; Pathologic lead point; Patient Discharge - standards; Pediatrics; Recurrence; Retrospective Studies; Surgery; Treatment Outcome; Recurrence; Pathologic lead point; Nonoperative management; Intussusception; Hydrostatic reduction; Emergency department discharge
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2010.02.085

Abstract Purpose The aim of this study was to evaluate whether discharge from the emergency department (ED) after successful hydrostatic reduction (HR) of intussusception is safe. Methods We conducted a single institution review of patient records with a diagnosis code of intussusception from 1995 to 2006. Data collected included age, clinical presentation, imaging, surgical interventions, pathology, recurrence, and disposition. Statistical analysis utilized χ2 tests, where P ≤ .05 was considered significant. Results A total of 309 patients with intussusception were identified. One hundred twenty-three patients (39.8%) required surgical intervention, 138 (44.6%) patients were managed nonoperatively as inpatients, and 48 (15.5%) were treated nonoperatively and discharged from the ED. There were 18 recurrences (5.8%). Recurrence rates did not significantly differ between patients who required operative reduction and those who were managed nonoperatively with HR and either observed as inpatients or discharged from the ED. Seven patients with recurrences required surgical intervention, and 1 of those children had a pathologic lead point, which was nonneoplastic. Conclusions Recurrence rates do not differ between children observed as inpatients and those discharged home after successful HR. Missed neoplastic pathologic lead points were not found in the patients who required an operation after a recurrence. Our data suggests that it is safe to discharge patients selectively from the ED after successful HR.