Outpatient management of intussusception: a systematic review and meta-analysis

• Published in: Journal of pediatric surgery 2019-07, Vol.54 (7), p.1316-1323
• Main Authors: Litz, Cristen N., Amankwah, Ernest K., Polo, Randall L., Sakmar, Kristen A., Danielson, Paul D., Chandler, Nicole M.
• Format: Article
• Language: English
• Subjects: Ambulatory management; Emergency department discharge; Intussusception; Outpatient management; Pediatric
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2018.09.019

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. 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. 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). 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. Treatment study. III.