Factors determining the need for operative reduction in children with intussusception: a population-based study.
OBJECTIVE
The objective of this study is to determine if children presenting to a nonteaching hospital were at greater risk for operative reduction of intussusception than those presenting to a teaching hospital.


METHODS
This population-based 8-year study included all children younger than 6 years with intussusception in the province of Ontario, Canada. Multiple logistic regression was used to model markers for operative reduction including age, sex, coexisting conditions, hospital type, and interhospital transfers.


RESULTS
Of the 961 children with intussusception, 25.4% had operative reduction. Risk factors for operative reduction were a diagnosis of Meckel's diverticulum and transfer from one institution to another after the initial diagnosis. One hundred forty-eight (15.4%) were transferred. Of those transferred and initially admitted to a nonteaching hospital, 87.4% (125/143) were transferred to a teaching hospital. Risk of operative reduction was higher in children transferred more than 1 day after admission (52.0% vs 39.0%). Odds ratios after adjusting for age, sex, and hospital type were 1.95 (95% confidence interval, 1.28-2.98; P < . 001) for those transferred on the same day and 3.31 (95% confidence interval, 1.34-7.28; P < .01) for those transferred after 24 hours.


CONCLUSIONS
Children who were presented to a nonteaching hospital and later transferred to a teaching hospital were at greater risk for operative reduction of intussusception, in particular, those who were transferred more than 1 day after admission. These data underline the importance of early diagnosis and timely management of intussusception.
Somme
Stig
S
Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
To
Teresa
T
Langer
Jacob C
JC