Variation in the Presentation of Intussusception by Age. Issue 8 (August 2020)

• Record Type: Journal Article
• Authors: Kimia, Amir A.; Hadar, Peter N.; Williams, Scotty; Landschaft, Assaf; Monuteaux, Michael C.; Bachur, Richard G.
• Is Part Of: Pediatric emergency care. Volume 36:Issue 8(2020)
• Publication Date: 2020-08
• Subjects: age -- intussusception -- variable presentation; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002179
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Objective: To compare the clinical presentation of intussusception among children younger and older than 24 months of age. Design/Methods: We performed a retrospective cross-sectional cohort study of children treated in the emergency department, aged 1 month to 6 years, who had an abdominal ultrasound to evaluate for intussusception over a 5-year period. After stratifying by an age cut-point of 24 months, univariate and multivariate analyses were performed. Results: One thousand two hundred fifty-eight cases of suspected intussusception were studied; median age was 1.7 years (interquartile range, 0.8, 2.9 years), and 37% were female. Intussusception was identified in 176 children (14%); 153 (87%) were ileocolic, and 23 were ileoileal. Abdominal pain (odds ratio, 4.0; 95% confidence interval [CI], 1.5–10.5), emesis (OR, 3.5; 95% CI, 1.8–6.7), bilious emesis (OR, 2.9; 95% CI, 1.5–5.7), lethargy (OR, 2.3; 95% CI, 1.3–5.7), rectal bleeding (OR, 2.8; 95% CI, 1.4–5.7), and irritability (OR, 0.4; 95% CI, 0.2–0.8) were found to be predictors in those younger than 24 months. In children older than 24 months, male sex was the only predictor identified (OR, 2.0; 95% CI, 1.1–3.7). In cases where abdominal radiographs were obtained (n = 1212), any abnormality on abdominal radiograph was found to be predictive in both age groups (OR, 7.8; 95% CI, 3.8–25.7; and OR, 3.1; 95% CI, 1.8–5.2, respectively). Conclusions: Intussusception presents differently in children younger than 24 months compared with older children. "Traditional" clinical predictors of intussusception should be interpreted with caution when assessing children older than 2 years.