ORIGINAL ARTICLE
Fluoroscopy Screen Time During Contrast Enema for the Evaluation and Treatment of Intussusception Rebekah Burns, MD,* Mark Adler, MD,Þ Ellen Benya, MD,þ and Bridgette Guthrie, MD, MSCIÞ
Objective: The objective of this study was to describe fluoroscopy screen time (FST) for children undergoing contrast enema (CE) for suspected intussusception. Methods: This is a single-center, retrospective cohort study of children younger than 7 years examined for intussusception by CE. We reviewed medical records for demographics, radiographic results, and FST. We used nonparametric descriptive statistical tests and calculated odds ratios (OR). Results: The median FST for 457 included CEs was 116 seconds. The median FST for positive CEs (n = 194) was 138 seconds (95% confidence interval [CI], 126 Y152); for negative CEs (n = 250), 86 seconds (95% CI, 78Y102); and for uncertain studies (n = 13), 138 seconds (95% CI, 89Y208) (P G 0.01). There was no difference in median FST if symptoms were present 24 hours or less versus longer than 24 hours. There was no difference between contrast types. Median FST for successful reductions was 122 seconds (95% CI, 114 Y138). In cases of failed reductions, median FST for those undergoing surgery was 277 seconds (95% CI, 195Y370) and 175 seconds (95% CI, 128Y271) (P G 0.01) for those undergoing delayed repeat CE. The OR for receiving a repeat CE was 1.3 (95% CI, 1.1Y1.4; P G 0.01) for every minute of FST. The OR for undergoing surgical reduction was 1.3 (95% CI, 1.2Y1.5; P G 0.01) for every minute of FST and 3.7 (95% CI, 2.0 Y 6.9; P G 0.01) for FST longer than 3 minutes. Conclusions: Fluoroscopy screen time for the evaluation and diagnosis of intussusception is shorter than that previously described. When an initial screening ultrasound is not available or nondiagnostic and the suspicion is high, further evaluation with a CE may be warranted because the radiation exposure is likely lower than that previously reported. Key Words: intussusception, radiation dose, radiology, ultrasound (Pediatr Emer Care 2014;30: 327Y330)
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ntussusception is the most common cause of intestinal obstruction in children younger than 2 years.1 It may present with a wide range of nonYspecific symptoms, making the initial diagnosis difficult and requiring providers to keep a high index of suspicion. The classic triad of intermittent abdominal pain, abdominal mass, and bloody stools is present in 20% of cases or less.2,3 ‘‘Typical’’ presenting features, such as vomiting and pain, may occur with the same frequency as that in children who are seen without underlying intussusception.4,5 From the *Department of Pediatrics, Division of Emergency Medicine, Seattle Children’s, University of Washington School of Medicine, Seattle, WA; †Department of Pediatrics, Division of Emergency Medicine, and ‡Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL. Disclosure: The authors declare no conflict of interest. Reprints: Rebekah Burns, MD, Department of Pediatrics, Division of Emergency Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, 4500 Sand Point Way, M.B.7.520, Seattle, WA, 98105 (e
Fluoroscopy Screen Time During Contrast Enema for the Evaluation and Treatment of Intussusception Rebekah Burns, MD,* Mark Adler, MD,Þ Ellen Benya, MD,þ and Bridgette Guthrie, MD, MSCIÞ
Objective: The objective of this study was to describe fluoroscopy screen time (FST) for children undergoing contrast enema (CE) for suspected intussusception. Methods: This is a single-center, retrospective cohort study of children younger than 7 years examined for intussusception by CE. We reviewed medical records for demographics, radiographic results, and FST. We used nonparametric descriptive statistical tests and calculated odds ratios (OR). Results: The median FST for 457 included CEs was 116 seconds. The median FST for positive CEs (n = 194) was 138 seconds (95% confidence interval [CI], 126 Y152); for negative CEs (n = 250), 86 seconds (95% CI, 78Y102); and for uncertain studies (n = 13), 138 seconds (95% CI, 89Y208) (P G 0.01). There was no difference in median FST if symptoms were present 24 hours or less versus longer than 24 hours. There was no difference between contrast types. Median FST for successful reductions was 122 seconds (95% CI, 114 Y138). In cases of failed reductions, median FST for those undergoing surgery was 277 seconds (95% CI, 195Y370) and 175 seconds (95% CI, 128Y271) (P G 0.01) for those undergoing delayed repeat CE. The OR for receiving a repeat CE was 1.3 (95% CI, 1.1Y1.4; P G 0.01) for every minute of FST. The OR for undergoing surgical reduction was 1.3 (95% CI, 1.2Y1.5; P G 0.01) for every minute of FST and 3.7 (95% CI, 2.0 Y 6.9; P G 0.01) for FST longer than 3 minutes. Conclusions: Fluoroscopy screen time for the evaluation and diagnosis of intussusception is shorter than that previously described. When an initial screening ultrasound is not available or nondiagnostic and the suspicion is high, further evaluation with a CE may be warranted because the radiation exposure is likely lower than that previously reported. Key Words: intussusception, radiation dose, radiology, ultrasound (Pediatr Emer Care 2014;30: 327Y330)
I
ntussusception is the most common cause of intestinal obstruction in children younger than 2 years.1 It may present with a wide range of nonYspecific symptoms, making the initial diagnosis difficult and requiring providers to keep a high index of suspicion. The classic triad of intermittent abdominal pain, abdominal mass, and bloody stools is present in 20% of cases or less.2,3 ‘‘Typical’’ presenting features, such as vomiting and pain, may occur with the same frequency as that in children who are seen without underlying intussusception.4,5 From the *Department of Pediatrics, Division of Emergency Medicine, Seattle Children’s, University of Washington School of Medicine, Seattle, WA; †Department of Pediatrics, Division of Emergency Medicine, and ‡Department of Medical Imaging, Ann & Robert H. Lurie Children’s Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL. Disclosure: The authors declare no conflict of interest. Reprints: Rebekah Burns, MD, Department of Pediatrics, Division of Emergency Medicine, Seattle Children’s Hospital, University of Washington School of Medicine, 4500 Sand Point Way, M.B.7.520, Seattle, WA, 98105 (e
