TY - JOUR
T1 - Outpatient management of intussusception
T2 - a systematic review and meta-analysis
AU - Litz, Cristen N.
AU - Amankwah, Ernest K.
AU - Polo, Randall L.
AU - Sakmar, Kristen A.
AU - Danielson, Paul D.
AU - Chandler, Nicole M.
N1 - Funding Information:
We acknowledge the support of the Johns Hopkins All Children's Clinical and Translational Research Track in the design and analysis of the systematic review and meta-analysis.?? Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - Ambulatory management
KW - Emergency department discharge
KW - Intussusception
KW - Outpatient management
KW - Pediatric
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U2 - 10.1016/j.jpedsurg.2018.09.019
DO - 10.1016/j.jpedsurg.2018.09.019
M3 - Review article
C2 - 30503194
AN - SCOPUS:85057224076
SN - 0022-3468
VL - 54
SP - 1316
EP - 1323
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 7
ER -