Pediatric Intussusception: Decreased Surgical Risk with Timely Transfer to a Children's Hospital.
Pediatric Intussusception: Decreased Surgical Risk with Timely Transfer to a Children's Hospital.
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DOI：
10.21767/2471-805x.100018
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发表时间：
2016-01-01
期刊：
影响因子：
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通讯作者：
Hunter M, Catherine J
中科院分区：
文献类型：
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作者：
Blackwood, Brian P;Theodorou, Christina M;Hunter M, Catherine J
简介：肠套叠是一种潜在的危及生命的疾病，也是生命最初两年肠梗阻的常见原因。我们假设，从外部社区医院，或奥什，没有三级保健能力的儿科服务，一个大的学术儿童医院肠套叠的患者转移更有可能需要手术治疗他们的肠套叠比那些谁是直接admitted.METHODS：电子病历查询病人介绍给安和罗伯特H。芝加哥Lurie儿童医院，诊断为肠套叠（2009年7月1日至2014年7月1日）。记录患者的年龄、性别、症状持续时间、影像学处理和手术治疗。对表现为转移的患者的奥什和转移报告进行分析。结果：共确诊肠套叠270例。232例（80%）非手术治疗成功。58例（20%）需要手术治疗。在需要手术的患者中，有38例复位（24例腹腔镜手术，14例开放手术）和20例肠切除术（1例腹腔镜手术，19例开放手术）。在需要手术的患者中，37例（63.8%）是从奥什转来的。我们发现，需要手术的转移患者在奥什平均花费7.77小时，而不需要手术的转移患者平均花费4.03小时（p=0.0188）。有没有显着差异的运输时间（p=0.44）。结论：总之，我们确定的时间量的患者在医院没有儿科手术能力作为一个独立的危险因素，需要手术治疗肠套叠。这些数据表明，肠套叠患者谁目前的医院没有儿科放射科或儿科手术，应加快转移的方式。如果在奥什灌肠复位失败，患者的转运不应延迟，因为这可能导致手术治疗的可能性更高。
INTRODUCTION: Intussusception is a potentially life-threatening condition, and a frequent cause of bowel obstruction during the first two years of life. We hypothesized that patients who were transferred from outside community hospitals, or OSH, without tertiary care capabilities for pediatric services to a large academic children's hospital with intussusception were more likely to require operative management for their intussusception than those who were directly admitted.METHODS: The electronic medical record was queried for patients presenting to Ann and Robert H. Lurie Children's Hospital of Chicago with a diagnosis of intussusception (July 1st, 2009-July 1st, 2014). Age, sex, symptom duration, radiologic management, and surgical care were recorded. OSH and transfer reports were analyzed for those patients that presented as a transfer. Statistical analysis was performed.RESULTS: We identified 270 patients with intussusception. 232 (80%) were successfully treated non-surgically. 58 (20%) required surgical management. Of the patients requiring surgery, there were 38 reductions (24 laparoscopic, 14 open) and 20 bowel resections (1 laparoscopic, 19 open). Of those patients requiring surgery, 37 (63.8%) had presented as a transfer from an OSH. We found that transferred patients, requiring surgery, spent a mean 7.77 hours at the OSH compared to 4.03 hours for the transferred patients that did not require surgery (p=0.0188). There was no significant difference in transport time (p=0.44).CONCLUSION: In conclusion, we identified the amount of time patients spend at hospitals without pediatric surgical capabilities as an independent risk factor necessitating surgical management of intussusception. These data suggest that patients with intussusception who present to hospitals without pediatric radiology or pediatric surgery, should be transferred in an expedited fashion. In the event of a failed enema reduction at an OSH, the transport of the patient should not be delayed as this may result in a higher likelihood of surgical management.