Discharge Strategies Following Successful Ileocolic Intussusception Reduction: Hospitalization vs Emergency Department Observation.

Abstract

To compare discharge strategies following successful ileocolic intussusception (ICI) reduction: inpatient hospitalization vs emergency department (ED) observation/discharge. This was a planned secondary analysis of children ages 4 months to 4 years with successful ICI from 86 pediatric centers in 14 countries between January 1, 2017 and December 31, 2019. We evaluated associations between discharge strategy for outpatient recurrent ICI (re-ICI). The primary outcome was ED return for re-ICI <48 hours and the secondary within the study period. We analyzed 2686 cases of ICI; 1588 (59%) admitted to hospital and 1098 (41%) discharged from ED with median (IQR) age of 18 (9, 28) months. During the study period 238 (8.9%) returned to the ED for ICI; 10.2% (112/1098) were discharged from the ED and 7.9% (126/1588) after inpatient hospitalization. Among these 238 patients, 66 (2.5%) returned <48 h most of whom had been discharged directly from the ED with a higher odds of a return visit <48 hours compared with those admitted (odds ratio [OR] = 4.27, CI = 2.50, 7.68; adjusted OR = 3.43, CI = 1.72, 7.29), and increased odds of returning within the study period (OR = 1.32, 95% CI 1.01, 1.72; adjusted OR = 1.48, 95% CI 1.03, 2.13). Upon return, the ICI re-reduction success rate was equally high in each group, ranging from 83.9% to 94.1%. Few children return to the ED with outpatient recurrent ICI, following successful reduction. Although the odds of return <48 hours due to re-ICI appear higher among patients discharged from the ED vs hospitalized, both groups have equally high rates of successful re-reduction. These findings suggest that clinicians should holistically weigh the risks and benefits, taking individual circumstances into account, to help reduce unnecessary hospitalizations.