Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients

Abstract

<b>BACKGROUND.</b> Radiologists generally treat pediatric ileocolic intussusceptions emergently given the potential for worse outcomes resulting from delayed reduction attempts. However, the relevant literature is conflicting. <b>OBJECTIVE.</b> The purpose of this study was to identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention given to the time since diagnosis. <b>METHODS.</b> This retrospective study included patients younger than 6 years old who underwent attempted image-guided enema reduction of ileocolic intussusception between May 2009 and July 2023. Patients were separated into two groups: those who presented directly to the institution (i.e., nontransferred patients, who all underwent attempted reduction < 8 hours after ultrasound diagnosis) and those who transferred to the study institution from outside facilities. EHR data were extracted. Each patient's first image-guided reduction attempt was classified as successful or unsuccessful. Univariable and multivariable analyses were performed. <b>RESULTS.</b> The study included 1065 patients (649 male and 416 female patients; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). For nontransferred patients, the mean interval between ultrasound diagnosis and the initial reduction attempt was 150.8 minutes; among transferred patients, the mean interval between advanced imaging at an outside facility (when documented) and the reduction attempt was 460.2 minutes (<i>p</i> < .001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (<i>p</i> = .25). For nontransferred patients, success occurred in 85.6% of attempts performed less than 2 hours after diagnosis versus 84.0% of attempts performed 2 to less than 8 hours after diagnosis (<i>p</i> = .54); the mean interval from diagnosis to attempted reduction was 149.7 and 156.8 minutes for successful and unsuccessful attempts, respectively (<i>p</i> = .53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR = 3.63, <i>p</i> < .001) and absence of high-risk ultrasound findings (OR = 2.57, <i>p</i> < .001); success was not independently associated with age, sex, bloody stools, reduction method used, or time since diagnosis of less than 2 hours (<i>p</i> > .05). For transferred patients, the mean interval from advanced imaging performed at an outside facility to attempted reduction was 463.1 and 440.2 minutes for successful and unsuccessful attempts, respectively (<i>p</i> = .74). <b>CONCLUSION.</b> Intussusception reduction may not require completion emergently (within 2 hours after diagnosis) but potentially may be safely performed on an urgent basis (within 8 hours). <b>CLINICAL IMPACT.</b> The findings have implications for determining the standard of care, including criteria for on-call activation of radiologic resources, in the management of pediatric intussusception.