title: Age at presentation and management of pediatric intussusception: A Pediatric Health Information System database study.
abstract: Intussusception is uncommon in children older than 3 years, and use of enema reduction in older children is controversial. We sought to determine whether older children are at greater risk of requiring operative intervention and/or having pathology causing lead points, such that enema reduction should not be attempted.
  
  
  
  The Pediatric Health Information System database was reviewed from January 1, 2009-June 30, 2014. Patients were followed for 6 months from initial presentation or until bowel resection occurred. Successful enema reduction was defined as having radiologic reduction without additional procedures.
  
  
  
  A total of 7,412 patients were identified: 6,681 were <3 years old, 731 patients were >3 years old. In those >3 years old, 450 (62%) were treated successfully with enema reduction; the rate of patients with a tumor diagnosis was similar in patients <3 years old and patients >3 years old (5% vs 6%, P = .07). The rate of a Meckel's diagnosis was greater in patients >3 years old (2% vs 14%, P < .0001). In patients >3 years old, duration of stay between patients who underwent primary operative therapy versus those who underwent operative therapy after enema reduction was similar (4 days vs 4 days, P = .06). Older age was not associated with increased risk of recurrent admission for intussusception (P = .45).
  
  
  
  Pediatric Health Information System data suggest that enema reduction may be safe and effective for a majority of children even if older than 3 years.
authors.affiliation: Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN; College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Kate B
authors.initials: KB
authors.lastname: Savoie
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Fridtjof
authors.initials: F
authors.lastname: Thomas
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Simonne S
authors.initials: SS
authors.lastname: Nouer
authors.affiliation: Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Max R
authors.initials: MR
authors.lastname: Langham
authors.affiliation: Department of General Surgery, University of Tennessee Health Science Center, Memphis, TN. Electronic address: ehuang@uthsc.edu.
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004733:Enema / Q000379:methods*; D005500:Follow-Up Studies; D063005:Health Information Systems; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000628:therapy*; D007223:Infant; D007443:Intussusception / Q000175:diagnosis / Q000628:therapy*; D010372:Pediatrics; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome