Effectiveness of the implementation of pediatric intussusception clinical pathway

Abstract

Intussusception is common among children at the pediatric emergency department (ED) with acute abdomen. Diagnosis and treatment delay remain a challenge. This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED. In January 2017, an intussusception management protocol was implemented for children with symptoms of intussusception. We retrospectively examined the charts of patients diagnosed with intussusception during the preprotocol (January 2015 to December 2016) and postprotocol (January 2017 to January 2019) periods and compared their outcomes. A total of 106 and 108 patients were included in the preprotocol and postprotocol groups, respectively. After CP implementation, the median door-to-ultrasonography time decreased from 66.5 (range: 13, 761) to 54 (20, 191) minutes; meanwhile, door-to-reduction time decreased from 121.5 (37, 1077) to 80.5 (40, 285) minutes; the median ED length of stay decreased from 440 to 303.5 minutes; and finally, admission rate increased from 18.9% to 40.7% ( P < .01). There was no between-group difference in the rates of complications, readmission, emergency surgery, or reduction failure. The implementation of an intussusception CP decreased time-to-diagnosis, time-to-treatment, and ED length of stay estimates among children screened using point-of-care ultrasonography. The present findings suggest that the implementation of an intussusception CP may improve the efficiency of time and resource use.

Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception

“…In one recent multicenter study, 38% of children transferred from an outside hospital had a negative intussusception evaluation at the receiving hospital, suggesting that these transfers may have been avoidable assuming there were no other indications for transfer 5 . Recent studies have also shown that clinical pathways for intussusception using a POCUS-first strategy lead to reduced times to diagnosis and treatment, and shorter ED length of stay without significant increases in negative outcomes 27,28 . Despite these benefits, the identification of intussusception using POCUS is not routinely taught across pediatric residency or PEM fellowship programs.…”

“…5 Recent studies have also shown that clinical pathways for intussusception using a POCUS-first strategy lead to reduced times to diagnosis and treatment, and shorter ED length of stay without significant increases in negative outcomes. 27,28 Despite these benefits, the identification of intussusception using POCUS is not routinely taught across pediatric residency or PEM fellowship programs. In a survey of PEM fellowship programs across the United States, only 64% of fellows reported specific POCUS training for intussusception.…”

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

“…A recent multicenter noninferiority study found that POCUS for intussusception performed by experienced clinician sonologists may be noninferior to that of RADUS [75]. A study evaluated the implementation of a POCUS pathway for children with suspected intussusception, and found that the use of POCUS could streamline their care, leading to decreased time-to-diagnosis, time-to-treatment, and EDLOS [82]. Similarly, a study by Kim et al [83] compared pre and postpathway implementation of a POCUS pathway for children, and found that the postpathway group resulted in shorter median EDLOS, door-to-reduction time and observation time.…”