Variation in the Presentation of Intussusception by Age

• Published in: Pediatric emergency care Vol. 36; no. 8; p. 372
• Main Authors: Kimia, Amir A, Hadar, Peter N, Williams, Scotty, Landschaft, Assaf, Monuteaux, Michael C, Bachur, Richard G
• Format: Journal Article
• Language: English
• Published: United States 01.08.2020
• Subjects: Abdominal Pain - diagnosis; Age Factors; Child; Child, Preschool; Cross-Sectional Studies; Emergency Service, Hospital; Female; Gastrointestinal Hemorrhage - diagnosis; Humans; Infant; Intussusception - diagnostic imaging; Irritable Mood; Lethargy; Male; Retrospective Studies; Ultrasonography - methods; Vomiting - diagnosis
• ISSN: 1535-1815
• DOI: 10.1097/PEC.0000000000002179

To compare the clinical presentation of intussusception among children younger and older than 24 months of age. 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. 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). 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.