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Evaluating and applying the current evidence on calculating intussusception reduction success rates
EP29175
Evaluating and applying the current evidence on calculating intussusception reduction success rates
Submitted on 14 Sep 2018

Pavan Nandra, Dilan Patel, Kirsteen McDonald, Jonathan Colledge, Anoushka Ljutikov
Paediatric Imaging Department, Royal London Hospital
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Poster Abstract
Title
Evaluating and applying the current evidence on calculating intussusception reduction success rates

Introduction
Intussusception occurs when bowel slides into adjacent bowel; also described as ‘telescoping’ [1]. The most common radiological management in the UK is reduction via fluoroscopically guided air-enema [2]. Previously, the success rates for this were calculated using the Selected Success Rate (SSR), based on the number of successful reductions as a percentage of all attempted reductions [3,4,5,6]. Recent literature and proposed British Society of Paediatric Radiology (BSPR) guidelines suggest a more representative marker is the Composite Reduction Rate (CoRR), based on the number of successful reductions as a percentage of the number of reductions that should be possible using air-enema, i.e. excluding those with a lead point/precluding pathology [3,7].

Aim
To review the air-enemas performed for intussusception patients in our centre during 2017, and calculate the SSR and CoRR.

Method
PACS search was performed using the relevant examination code, yielding 22 results (after exclusions) in 2017. Data was collected for each case and the operative outcome of each unsuccessful case was reviewed on the electronic patient record.

Results
14 of the 22 air-enemas were successful (SSR=63.6%). Of the 8 unsuccessful cases, 4 were found to have a lead point/pathology requiring resection, and 2 were found to already be reduced on laparoscopy/laparotomy. When these 6 cases are excluded (as they are not defined as failures) the CoRR is 14/16=87.5%.

Conclusion
The CoRR is a more representative measure of intussusception reduction success rates than the SSR, accounting for patient pathology and outcome. Our centre achieved a CoRR of 87.5%.



[1] Gluckman S, Karpelowsky J, Webster AC, McGee RG. Management for intussusception in children. Cochrane Database of Systematic Reviews 2017, Issue 6. DOI: 10.1002/14651858.CD006476.pub3
[2] Williams H. Imaging and intussusception. Arch Dis Child Educ Pract Ed 2008; 93:30-36. DOI: 10.1136/adc.2007.134304
[3] BSPR Intussusception Working Group. A UK evidence based guideline for the acute management of paediatric intussusception 2017
[4] Hannon E, Williams R, Allan R, Okoye B. UK intussusception audit: A national survey and audit of reduction rates. Clin Rad 2014 (69) 344-349. DOI: 10.1016/j.crad.2013.10.024
[5] Samad L, Marven S, El Bashir H, Sutcliffe AG, Cameron JC, Lynn R, Taylor B. Prospective surveillance study of the management of intussusception in UK and Irish infants. Br J Surg 2012; 99 (3); 411-5
[6] Rosenfeld K, McHugh K. Survey of intussusception reduction in England, Scotland and Wales: how and why we could do better. Clinical Radiology 1999; 54: 452-45
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