Other Gastrointestinal Condition
Diagnosis and treatment of childhood intussusception from 1997 to 2016: A population-based study☆,☆☆,★

https://doi.org/10.1016/j.jpedsurg.2020.01.049Get rights and content

Abstract

Objectives

Describe changes in the diagnostic approach and treatment for pediatric intussusception over two decades.

Study design

Administrative universal healthcare data were used to conduct a population-based cohort study of intussusception between January 1997 and December 2016 in Ontario, Canada.

A validated case definition was used to identify all patients (< 18 years) treated for intussusception in the province at community or tertiary care centers. Treatment modality was determined using physician billing data and databases linked at ICES; it was categorized as nonoperative alone, surgical alone, or failed nonoperative. Descriptive statistics, Cochrane–Armitage for trend analyses, and graphical and multinomial logistic regression were performed.

Results

Over 20 years, 1895 pediatric patients were treated for intussusception. Pretreatment imaging use rose from 57.5% to 99.3%. Nonoperative management increased from 23.4% to 75.2%. However, 43% of children who presented to a community hospital underwent immediate surgical management, compared with just 11% of children at tertiary centers (RR 0.39, 95% CI: 0.25–0.62). Among children who underwent surgery, there was an increase in bowel resection over time (41.7% to 57.6%).

Conclusions

Over the 20 year period of study, pretreatment imaging became universal, and management shifted from predominantly surgical to nonoperative reduction in Ontario. The rate of surgical intervention remains higher in community versus tertiary centers.

Level of evidence

Treatment study, III.

Section snippets

Study population and case definition

The study cohort was defined as Ontario residents less than 18 years of age who had an emergency room visit and/or hospital admission for treatment of intussusception between January 1, 1997, and December 31, 2016. Universal coverage for physician care and hospital services is provided to all Ontario residents through the Ontario Health Insurance Program (OHIP). The ICES data comprise the linked databases of coded universal coverage health service records for Ontario residents. A validated case

Study population

A total of 1895 patients less than 18 years of age underwent treatment for intussusception in Ontario during the 20-year study period from 1997 to 2016. Overall 35.5% of patients were female, and 57.5% were younger than 24 months. Patients were equally distributed across income quartiles. Patient characteristics by year of presentation are shown in Table 1. An additional 1779 patients had the diagnostic code for intussusception but no associated treatment codes and were excluded from further

Discussion

This is the first population-based study to describe the management of pediatric intussusception in the context of changing diagnostic and treatment options. The treatment of intussusception has changed quite dramatically over the past two decades in Ontario. Pretreatment imaging has become standard. Whereas in 1997 surgery was the most common first-line treatment approach (55.3%), nonoperative reduction was attempted in 94.8% of patients and was the only modality used in 75.2% of patients by

Conclusions

The management of intussusception has changed dramatically in the past two decades in Ontario. Nonoperative reduction has become much more common as first line management although its success-rate remains variable. Overall complications of perforation, readmission, and mortality remained low across all modalities of treatment. Patients presenting to community centers are far more likely to undergo surgery alone. Further study is needed to determine the factors that contributed to this disparity

References (17)

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Funding sources: The Department of Surgery at Queen's University. This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC).

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Financial disclosures: The authors have no financial relationships relevant to this article to disclose.

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Conflict of interest: The authors have no potential conflicts of interest to disclose.

1

Present address: Department of Pediatric Surgery, Alberta Children's Hospital, 28 Oki Drive, Calgary, AB Canada T3B 6A8.

2

Present address: Canadian Institute for Health Information.

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