Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study

Abstract

Intussusception is uncommon in children older than 3years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted. The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014. Patients were followed for 6months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures. A total of 7,412 patients were identified: 6,681 were <3years old, 731 patients were >3years old. In those >3years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3years old and patients >3years old (5% vs 6%, P=.07). The rate of a Meckel's diagnosis was greater in patients >3years old (2% vs 14%, P<.0001). In patients >3years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4days vs 4days, P=.06). Older age was not associated with increased risk of recurrent admission for intussusception (P=.45). Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3years.