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Outpatient management of intussusception: a systematic review and meta-analysis. J Pediatr Surg 2019 Jul;54(7):1316-1323

Date

12/07/2018

Pubmed ID

30503194

DOI

10.1016/j.jpedsurg.2018.09.019

Scopus ID

2-s2.0-85057224076 (requires institutional sign-in at Scopus site)   10 Citations

Abstract

BACKGROUND: Variability in management of intussusception after enema reduction exists. Historically, inpatient observation was recommended; however, there is a lack of evidence-based guidelines for this practice.

METHODS: A systematic review and meta-analysis evaluating outcomes between inpatient (IP) and outpatient (OP) management after enema reduction was performed. The following databases were searched: PubMed, EBSCOhost CINAHL, EMBASE, Web of Science, and Cochrane Database. Data from an institutional review were included in the meta-analysis.

RESULTS: Ten studies of patients aged 0-18 years with intussusception who underwent successful enema reduction that reported outcomes of outpatient management were included. Overall recurrence rates were 6% for IP and 8% for OP (p = 0.20). Recurrences within 24 (IP: 1% vs OP: 0%, p = 0.90) and 48 h (IP: 1% vs OP: 2%, p = 0.11) were similar. There was no significant difference in the rate of return to the emergency department (IP: 6% vs OP: 14%, p = 0.11). Both groups had a similar rate of requiring an operation (IP: 2% vs OP: 1%, p = 0.84).

CONCLUSIONS: Outpatient management of intussusception after enema reduction results in a shorter hospital stay with no difference in the rate of return to the emergency department, recurrence, need for operation, or mortality. The findings of the meta-analysis suggest that outpatient management may be safe and could reduce hospital resource utilization.

TYPE OF STUDY: Treatment study.

LEVEL OF EVIDENCE: III.

Author List

Litz CN, Amankwah EK, Polo RL, Sakmar KA, Danielson PD, Chandler NM

Author

Ernest Amankwah PhD Director, Associate Professor in the Clinical and Translational Science Institute department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Databases, Factual
Enema
Female
Humans
Ileal Diseases
Infant
Infant, Newborn
Intussusception
Male
Outpatients
Recurrence