Discharge after Reduction of Intussusception Is Safe and Effective

The study is entitled Emergency Department discharge following successful radiologic reduction of ileocolic intussusception in children, a protocol-based prospective observational study, from Children's Mercy Hospital in Kansas City with Joseph Sushka as first author and Shawn St. Peter as senior author

Previously, the hospital had a protocol wherein all patients who had reduction of intussusception were admitted for observation to rule out recurrence

The authors felt that due to the low rate of recurrence in this patient population, they could be safely managed as outpatients

The study compared outcomes from 115 patients after implementation of the protocol to 90 patients prior to its adoption

In the new protocol, any patient with a diagnosis of intussusception received a surgical consult

Patients with peritoneal signs were taken to the operating room immediately

Patients without peritoneal signs underwent air contrast enema for attempted reduction

If the intussusception was unable to be reduced after three attempts, patients were taken to the operating room

If the reduction was successful, patients were observed in the ED for four hours

If patients had no recurrent symptoms during the 4-hour ED stay, they were discharged home

If symptoms returned during observation, patients had repeat ultrasound and repeat enema if the intussusception had returned

All patients who required repeat reduction were admitted for observation

When comparing the two groups, the authors found no difference in the rate of successful enema reduction

Once the new protocol was instituted, admission rate was reduced from 100% down to 33%

There was no difference in the rate of operative intervention between the two groups

There was no difference in the rate of recurrence between the two groups

Total length of stay was reduced by 15 hours after protocol implementation

There was no difference in readmission within 30 days between the two groups

There were no morbidities or major complications from doing this new protocol

In the post-protocol group, there was a decrease in admission by 66%

The length of stay was reduced by 15 hours in the post-protocol group

In the post-protocol group, there was an increased rate of return to the emergency department within 30 days

There was a shorter time frame from discharge to return to the ED in the post-protocol group

The increased ED return rate did not result in an actual increased readmission rate

The authors concluded that after successful reduction of intussusception, children can be observed in the emergency department and then discharged home if they have no recurrence of symptoms