A Practice Guideline for Postreduction Management of Intussusception of Children in the Emergency Department.
OBJECTIVE
The aim of this study was to evaluate the effects of a practice guideline of postreduction management of intussusception in children on the length of stay (LOS) from reduction in the pediatric emergency department (PED) and on the incidence of recurrence.


METHODS
We developed a practice guideline of postreduction management of intussusception in the PED. The practice guideline involved feeding 2 hours after reduction and discharge 2 hours after successful feeding. The guideline was implemented on October 1, 2012. Retrospective quasi-experimental study was conducted for evaluation of the difference in LOS in the PED after reduction of intussusceptions, and the recurrence rate of intussusceptions between the preimplementation and postimplementation periods. Piecewise regression was performed to determine the differences between groups.


RESULTS
In total, 45 and 52 patients were included in the preimplementation and postimplementation periods, respectively. The median LOS in the postimplementation period was significantly shorter than that in the preimplementation period (289 vs 532 minutes, respectively; P = 0.001). The slope of the LOS changed from 0.68 to -0.29. The slope decreased by 0.97 after practice guideline implementation. This difference was not statistically significant (P = 0.123), but it changed from a positive to negative gradient. The recurrence rate was not significantly different between the 2 periods (P = 0.605).


CONCLUSIONS
Implementation of a practice guideline involving early feeding and discharge after reduction of intussusception resulted in a reduced LOS from reduction of intussusception in the PED and was not associated with recurrence of intussusception.
From the Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang, Seongnam, Gyeonggi.
Hyuksool
H
Kwon
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul.
Jin Hee
JH
Lee
Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Gyeongsangnam.
Jin Hee
JH
Jeong
Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang, Seongnam, Gyeonggi, Republic of Korea.
Hye Ran
HR
Yang
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul.
Young Ho
YH
Kwak
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul.
Do Kyun
DK
Kim
From the Department of Emergency Medicine, Seoul National University Bundang Hospital, Bundang, Seongnam, Gyeonggi.
Kyuseok
K
Kim
D000293:Adolescent; D000328:Adult; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D015994:Incidence; D007443:Intussusception / Q000453:epidemiology* / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data* / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data* / Q000639:trends; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012189:Retrospective Studies; D055815:Young Adult