Practice variation in the management of pediatric intussusception: a narrative review

Abstract

Ileocolic intussusception, a major cause of acute intestinal obstruction in young children, necessitates rapid diagnosis and a multidisciplinary treatment approach. A recent large study identified variations in pain management, sedation, and non-operative reduction methods in these patients. We aimed to explore variability within the diagnostic and treatment pathways of ileocolic intussusception. A narrative review of the literature was conducted for peer-reviewed articles published in English between 2004 and 2024. We searched the electronic databases Ovid, Embase, Scopus, PubMed, and the Cochrane Database. Google Scholar was searched using the search terms "intussusception," "triage," "diagnosis," emergency department," "radiology," "ultrasound," "POCUS," "reduction," "air-enema," "fluid-enema," "pneumatic," "hydrostatic," "pain," "sedation," "operating-room," "laparoscopy," and "surgery" to identify articles published in electronic journals, books, and scientific websites. Data were analyzed by a multidisciplinary team of specialists in pediatric emergency medicine, pediatric radiology, and pediatric surgery. Fifty-six papers were included in this review. Six areas of practice variation were found: pain management in triage, the use of point-of-care ultrasound in the emergency department, the use of pneumatic versus hydrostatic technique for the reduction procedure, performing the reduction procedure under sedation, patient observation after an uncomplicated reduction, and the use of open surgery or laparoscopy for patients who underwent unsuccessful reduction.

Conclusion: This review has identified practice variations in several key areas of ileocolic intussusception management. The findings underscore the need for further research in these areas and the establishment of uniform standards aimed at improving the care of children with ileocolic intussusception.

What is known: • Ileocolic intussusception necessitates rapid diagnosis and a collaborative treatment approach involving emergency medicine, radiology, surgery, and often anesthesia. • A previous study reported variations in the practice of pain management and sedation among these patients.

What is new: • This narrative review identified practice variations in several key areas within the diagnostic and treatment pathways of ileocolic intussusception.

Keywords: Emergency department; Pneumatic reduction; Practice variation.