Fluoroscopy screen time during contrast enema for the evaluation and treatment of intussusception

Burns, R.; Adler, M.; Benya, E.; Guthrie, B.

Pediatr Emerg Care. 2014 Apr 25; 30(5):327-30

Abstract

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], 126-152); for negative CEs (n = 250), 86 seconds (95% CI, 78-102); and for uncertain studies (n = 13), 138 seconds (95% CI, 89-208) (P < 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, 114-138). In cases of failed reductions, median FST for those undergoing surgery was 277 seconds (95% CI, 195-370) and 175 seconds (95% CI, 128-271) (P < 0.01) for those undergoing delayed repeat CE. The OR for receiving a repeat CE was 1.3 (95% CI, 1.1-1.4; P < 0.01) for every minute of FST. The OR for undergoing surgical reduction was 1.3 (95% CI, 1.2-1.5; P < 0.01) for every minute of FST and 3.7 (95% CI, 2.0-6.9; P < 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.

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