Gastrostomy tube replacement in a pediatric ED: frequency of complications and impact of confirmatory imaging.
BACKGROUND
Gastrostomy tube (g-tube) dislodgement is a common problem in special needs children. There are no studies on the frequency of complications after g-tube replacement for children in a pediatric emergency department (ED).


OBJECTIVE
The objective of this study is to determine the frequency of misplacement and subsequent complications for children undergoing g-tube replacement in a pediatric ED and the impact of contrast-enhanced confirmatory imaging on ED length of stay (LOS).


METHODS
This was a retrospective review of children presenting to a pediatric ED over 16 months. Subjects were included if they underwent g-tube replacement in the ED. Records were reviewed for historical and procedural data including patient age, g-tube age, ED LOS, documented difficulties replacing the tube, performance of confirmatory imaging (contrast-enhanced radiograph), and complications identified within 72 hours of ED visit.


RESULTS
A total of 237 children met inclusion criteria. Three (1.2%) had evidence of g-tube misplacement, all of whom underwent confirmatory imaging. One complication from misplacement was identified (gastric outlet obstruction from overfilled balloon). Tract disruption was not identified for any subject. Eighty-four subjects (35%) had confirmatory imaging performed after replacement. Mean ED LOS in the imaged group was 265 vs 142 minutes for the nonimaged group (P < .001). No subjects with documentation of clinical confirmation had subsequent evidence of misplacement.


CONCLUSIONS
For children undergoing g-tube replacement in a pediatric ED, misplacement and associated complications were rare. Confirmatory imaging was associated with a considerably longer LOS. In the presence of clinical confirmation, confirmatory imaging may be judiciously used.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Cory.Showalter@gmail.com
Cory D
CD
Showalter
Benjamin
B
Kerrey
Stephanie
S
Spellman-Kennebeck
Nathan
N
Timm
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D004868:Equipment Failure; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography / Q000379:methods; D012189:Retrospective Studies; D055815:Young Adult