Moss RL, Participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: Participants or investigators enrolling participants could possibly foresee assignments and thus introduce selection bias, such as allocation based on: Insufficient information to permit judgement of Low risk or High risk. This limits the strength of our conclusions and our ability to investigate both clinical and statistical heterogeneity. One trial (Franken 1983) successfully blinded participants and personnel through the use of premade identical appearing vials of drug and placebo. Introduction. #4 MeSH descriptor Infant explode all trees To locate unpublished studies, we contacted content experts, searched the World Health Organization International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (September 2016), and explored proceedings from meetings of the British Association of Paedatric Surgeons (BAPS), the American Soceity of Pediatric Surgery, and the World Congress of Pediatric Surgery. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. Two review authors (SG and RGM) independently extracted data and assessed risk of bias using a standardised data extraction form. Intussusception in Children - What You Need to Know Only one trial (Essa 2011) reported adverse outcomes for surgical interventions, including number of participants requiring manual reduction and number requiring bowel resection. Pitan OC, Interventions utilised must be standardised and clearly defined. Comparison 1 Enema plus glucagon versus enema alone, Outcome 1 Successfully reduced intussusception. In others, the potential for poorly perfused or dilated bowel to translocate and produce a bacteraemia is seen as an indication. Although we did not discuss these matters in the protocol, we used the GRADE approach and 'Summary of findings' tables to summarise our findings. Review the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by intussusception. (infant* or child* or newborn*).mp. In rare cases, these events can cause death. Mast TC, 3 and 6 Kamagata S, Elliott EJ, The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception. Parashar U, 2022 Nov 14;9(11):1745. doi: 10.3390/children9111745. (exp animal/ or exp invertebrate/ or animal.hw. The role of antibiotics is unclear. This outcome was not reported for this comparison. Intussusception is a common abdominal emergency in children with significant morbidity. Again, trials infrequently reported data related to adverse events and harms. Additional treatment recommended for SOME patients in selected patient group. 2019 Feb;29(1):7-13. doi: 10.1055/s-0038-1668145. It often occurs near the ileocecal junction and rarely only involves the colon ( 1, 2 ). A small sample of 15 children underwent surgical intervention nine underwent manual reduction and the remaining six had a bowel resection. Uba FA. Patterns of management of intussusception outside tertiary centres, Intussusception, Part 1: A review of diagnostic approaches, Intussusception, Part 2: An update on the evolution of management, The ins and outs of intussusception: history and management over the past fifty years. The incidence of intussusception . Applegate 2009 included comparative trials as well as RCTs to examine the role of ultrasonography, air versus liquid enema for reduction, and risk of bowel perforation in children with intussusception. Cachat 2012 performed a metaanalysis of studies examining children with radiologically confirmed intussusception, including RCTs and retrospective comparative studies, to compare rates of recurrence. We also examined proceedings from meetings of the British Association of Paedatric Surgeons (BAPS), the American Society of Pediatric Surgery, and the World Congress of Pediatric Surgery (20092015). et al. It is important to note that surgical intervention was not the primary study question for any of the included studies. However, this review included only six trials. FOIA It is uncertain whether use of glucagon improves the rate of successful reduction of intussusception when compared with enema alone (reported in two trials, 218 participants; RR 1.09, 95% CI 0.94 to 1.26;low quality of evidence). Fitzgerald RJ. We identified six completed trials of 822 participants in which all children had presented for management of intussusception. Antibiotics. air, saline, or barium) into the rectum via a rectal tube to reduce the intussusceptum by increasing intraluminal pressure (Davis 2003). Zou KH, Huppertz HI, Beres AL, Kusakawa I, Gray MP, Intussusception is a condition that causes part of the bowel to fold into itself like a telescope. Rolle U. Intussusception in children clinical presentation, diagnosis and management, The International Journal of Colorectal Disease, Intussusception: the paediatric radiologist's perspective. Two of the seven remaining publications were duplicates; thus we included them as one trial (Lin 2000). 2015 Sep;22(9):1042-7. doi: 10.1111/acem.12741. Review authors combined barium and saline into a liquid enema group for comparison with air enema. Epub 2015 Aug 20. 9,10. Who is more likely to get intussusception? government site. GonzalezSpinola J, We judged the remaining four trials as having unclear risk. Borenstein M, Outcomes should be standardised and data related to safety and harm should be included. All included trials provided evidence of low quality and were subject to serious concerns about imprecision, high risk of bias, or both. Insufficient rationale or evidence that an identified problem will introduce bias. We described results while taking into account the quality of evidence and the importance (size) of the effect as follows. This list of 15 cases was used repeatedly throughout the study (10 times) with random sequence every time. This allocation sequence is predictable, No missing data (randomisation post exclusion). Wohlfahrt J, See summary of findings tables (Table 1; Table 2; Table 3). EA, Both Hadidi 1999 and Meyer 1993 used random number tables that may have allowed for prediction of intervention by participants. Air and liquid contrast agents in the management of intussusception: a controlled, randomized trial, Hydrostatic reduction of childhood intussusception. The episodes typically last 15 to 20 minutes. The intestine can swell and bleed. et al. Okoro CA, This causes pain, vomiting, and obstruction, preventing passage. Ein SH, Searches for ongoing trials revealed three (El Fiky 2016; Mehraeen 2011; Zhang 2015), for which no results were available. After exclusion of duplicates and ongoing trials, 435 unique records remained. The https:// ensures that you are connecting to the 12. placebo.ab. Schmit P, Hirschl RB, Intussusception is a common abdominal emergency in children with significant morbidity. Kohl KS, Cameron JC, Other adjuvants include antibiotics (Ein 2006; Moss 2000; Pepper 2012). Debate also surrounds the best approach for its surgical management (i.e. We were not blinded to study details during this process. Shahramian I, Parooie F, Mirabbasi SA, Salarzaei M. Wien Med Wochenschr. Serour F, A tumor or polyp (a growth inside the intestine) Intussusception is the most common cause of intestinal blockage in children between 3 months and 3 years of age. With early diagnosis, appropriate fluid resuscitation, and therapy, the mortality rate from intussusception in children is less than 1%. Clifford CR, Preparation included a nasogastric tube with drainage of the stomach, intravenous fluid deficit replacement, and intravenous metronidazole and cefotaxime, "randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. Your child was seen today in Children's Emergency Services and treated for . Br G, A report prepared for the Steering Committee on Diarrhoeal Disease Vaccines, Vaccine Development,Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. Ukiyama E, Koch A, Whether the treatment was an enema or surgery, your child will stay in the hospital overnight in case it . Diarrhea in Children: Why It Happens & How To Stop It - WebMD Karp MP, J Pediatr Surg. We resolved disagreements by consensus, involving a third review author (ACW) when required. Black SB, Deeks JJ, This equates to a number needed to treat for an additional beneficial outcome of 6 (95% CI 4 to 19). Intussusception in Children - Stanford Medicine Children's Health Although Cachat found that dexamethasone was beneficial in reducing rates of recurrence of intussusception among children, review findings suggest that risk of recurrence of intussusception is low, and that regardless of the technique used for successful reduction, it is safe to discharge a patient after performing successful reduction. Intussusception (see the image below) is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. We attempted to contact study authors but received no response. Inclusion in an NLM database does not imply endorsement of, or agreement with, Medical Encyclopedia Intussusception - children Intussusception - children Intussusception is the sliding of one part of the intestine into another. 3. Berlin JA. We obtained only data for the outcomes 'liquid enema plus glucagon versus liquid enema alone' and 'air enema versus liquid enema' from two trials each, and data for all other outcomes from single trials only, most with small sample sizes. 17. random*.ti,ab. Tamimi G, Symptoms include abdominal pain, which may wax and wane, vomiting, bloating, and bloody stool. Seeger JD. Hyodo S, Reporting of methods was incomplete for most trials, as shown in Figure 2 and Figure 3. Only one trial reported postoperative complications, but owing to the method of reporting used, a quantitative analysis was not possible. This procedure involves introducing a substance (air or liquid) into the bowel, via the rectum, with a particular pressure that reduces the 'telescoped' bowel into its normal position. Bloody stool. Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. Acad Emerg Med. Presentation often includes colicky abdominal pain, flexing of the legs, fever, lethargy, and vomiting, with blood in the stool in some cases. Bines JE, Current radiological management of intussusception in children. We planned to assess differences among subgroups using analysis of variance (Altman 1996). We entered relevant data into Review Manager software (RevMan version 5.3) (RevMan 2014). We judged the quality of evidence according to the following factors. Prospective surveillance study of the management of intussusception in UK and Irish infants, Epidemiology of intussusception in children: national surveillance and use of record linkage to validate the incidence, and study of incidence trends [Doctoral Thesis]. MacCarthy J, Sydney Adventist Hospital, University of Sydney, Wahroonga NSW 2076, SydneyAustralia, Children's Hospital at Westmead, Department of Paediatric Surgery, SydneyAustralia, The University of Sydney, Sydney School of Public Health, Edward Ford Building A27, SydneyNSWAustralia, 2006, The Children's Hospital at Westmead, Institute of Endocrinology and Diabetes, Locked Bag 4001, WestmeadNSWAustralia, 2145, Number of children with successfully reduced intussusception, characterised by radiologically confirmed passage of contrast media into the ileum, Number of children with radiologically confirmed or clinically suspected (intraoperative or endoscopic) bowel perforation(s), Number of children with recurrent intussusception (recurrence is defined as occurring after a minimum of 12 hours following a successful reduction), Number of children who underwent a bowel resection (defined by any transection of the lumen, with removal of a segment of bowel), Number of children with a diagnosis of sepsis (defined as lifethreatening organ dysfunction caused by a dysregulated host response to infection (, Radiation exposure (measured in milliSieverts (mSv)) resulting from intervention, Length of hospitalisation (measured in days) associated with intervention, Intraluminal pressure (measured in mm Hg) used to achieve reduction, Number of attempts required to achieve successful reduction, Length of operation (measured in minutes) in the case of surgical intervention, Number of intraoperative complications (as defined by study authors) in the case of surgical intervention, Number of postoperative complications (as defined by study authors) in the case of surgical intervention, Number of intraoperative conversions (i.e.
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