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Nationwide Population-Based Epidemiologic Study on Childhood Intussusception in South Korea: Emphasis on Treatment and Outcomes

  • Lee, Eun Hye (Department of Pediatrics, Nowon Eulji Medical Center) ;
  • Yang, Hye Ran (Department of Pediatrics, Seoul National University Bundang Hospital)
  • Received : 2019.09.30
  • Accepted : 2020.03.06
  • Published : 2020.07.15

Abstract

Purpose: This was a nationwide population-based study conducted to investigate the epidemiology, treatment, disease outcomes, and associated factors of childhood intussusception in South Korea. Methods: Data from the Korean National Health Insurance Service database on all patients <18 years old diagnosed with intussusception from 2007 to 2017 were analyzed. Results: A total of 34,688 cases were identified among 30,444 patients. The overall incidence was 28.3/100,000 person-years with a male predominance. Most cases (83.1%) occurred in children <3 years old, with an annual incidence of 195.2, 200.1, and 118.6 cases per 100,000 children in their first, second, and third year of life, respectively. The median age at the first occurrence was 18.7 months, and it was higher in boys than in girls. The post-discharge recurrence rate was 10.6% (3,226/30,444) and the in-hospital recurrence rate was 6.1% (1,842/30,444). The total recurrence rate (post-discharge recurrence and/or in-hospital recurrence) was 15.0% (4,580/30,444). Enema reduction was successful in 90.0% of cases. Enema reduction was more successful in girls than in boys. A total of 3,296 (10.8%) patients underwent 3,481 surgeries, including 735 (21.1%) laparoscopic surgeries. Post-discharge recurrence and surgery were significantly affected by age, sex, and hospital type. Mortality was noted in nine cases (0.03%). Conclusion: Our study provides accurate epidemiologic data on the treatment and outcomes of intussusception through complete enumeration during an 11-year-period.

Keywords

References

  1. Parashar UD, Holman RC, Cummings KC, Staggs NW, Curns AT, Zimmerman CM, et al. Trends in intussusception-associated hospitalizations and deaths among US infants. Pediatrics 2000;106:1413-21. https://doi.org/10.1542/peds.106.6.1413
  2. Bruce J, Huh YS, Cooney DR, Karp MP, Allen JE, Jewett TC Jr. Intussusception: evolution of current management. J Pediatr Gastroenterol Nutr 1987;6:663-74. https://doi.org/10.1097/00005176-198709000-00003
  3. Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg 2017;30:30-9. https://doi.org/10.1055/s-0036-1593429
  4. Lioubashevsky N, Hiller N, Rozovsky K, Segev L, Simanovsky N. Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation? Radiology 2013;269:266-71. https://doi.org/10.1148/radiol.13122639
  5. Chen SC, Wang JD, Hsu HY, Leong MM, Tok TS, Chin YY. Epidemiology of childhood intussusception and determinants of recurrence and operation: analysis of national health insurance data between 1998 and 2007 in Taiwan. Pediatr Neonatol 2010;51:285-91. https://doi.org/10.1016/S1875-9572(10)60055-1
  6. Trotta F, Da Cas R, Bella A, Santuccio C, Salmaso S. Intussusception hospitalizations incidence in the pediatric population in Italy: a nationwide cross-sectional study. Ital J Pediatr 2016;42:89. https://doi.org/10.1186/s13052-016-0298-8
  7. Jenke AC, Klaassen-Mielke R, Zilbauer M, Heininger U, Trampisch H, Wirth S. Intussusception: incidence and treatment-insights from the nationwide German surveillance. J Pediatr Gastroenterol Nutr 2011;52:446-51. https://doi.org/10.1097/MPG.0b013e31820e1bec
  8. Ducharme R, Benchimol EI, Deeks SL, Hawken S, Fergusson DA, Wilson K. Validation of diagnostic codes for intussusception and quantification of childhood intussusception incidence in Ontario, Canada: a population-based study. J Pediatr 2013;163:1073-9.e3. https://doi.org/10.1016/j.jpeds.2013.05.034
  9. Huppertz HI, Soriano-Gabarro M, Grimprel E, Franco E, Mezner Z, Desselberger U, et al. Intussusception among young children in Europe. Pediatr Infect Dis J 2006;25(1 Suppl):S22-9. https://doi.org/10.1097/01.inf.0000197713.32880.46
  10. Jiang J, Jiang B, Parashar U, Nguyen T, Bines J, Patel MM. Childhood intussusception: a literature review. PLoS One 2013;8:e68482. https://doi.org/10.1371/journal.pone.0068482
  11. Tate JE, Simonsen L, Viboud C, Steiner C, Patel MM, Curns AT, et al. Trends in intussusception hospitalizations among US infants, 1993-2004: implications for monitoring the safety of the new rotavirus vaccination program. Pediatrics 2008;121:e1125-32. https://doi.org/10.1542/peds.2007-1590
  12. Chen YE, Beasley S, Grimwood KNew Zealand Rotavirus Study Group. Intussusception and rotavirus associated hospitalisation in New Zealand. Arch Dis Child 2005;90:1077-81. https://doi.org/10.1136/adc.2005.074104
  13. Takeuchi M, Osamura T, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S. Intussusception among Japanese children: an epidemiologic study using an administrative database. BMC Pediatr 2012;12:36. https://doi.org/10.1186/1471-2431-12-36
  14. Hong Kong Intussusception Study Group. Intussusception trends in Hong Kong children. Hong Kong Med J 2007;13:279-83.
  15. Justice FA, Auldist AW, Bines JE. Intussusception: trends in clinical presentation and management. J Gastroenterol Hepatol 2006;21:842-6. https://doi.org/10.1111/j.1440-1746.2005.04031.x
  16. Fischer TK, Bihrmann K, Perch M, Koch A, Wohlfahrt J, Kare M, et al. Intussusception in early childhood: a cohort study of 1.7 million children. Pediatrics 2004;114:782-5. https://doi.org/10.1542/peds.2004-0390
  17. Buettcher M, Baer G, Bonhoeffer J, Schaad UB, Heininger U. Three-year surveillance of intussusception in children in Switzerland. Pediatrics 2007;120:473-80. https://doi.org/10.1542/peds.2007-0035
  18. Samad L, Cortina-Borja M, Bashir HE, Sutcliffe AG, Marven S, Cameron JC, et al. Intussusception incidence among infants in the UK and Republic of Ireland: a pre-rotavirus vaccine prospective surveillance study. Vaccine 2013;31:4098-102. https://doi.org/10.1016/j.vaccine.2013.06.084
  19. Yen C, Tate JE, Steiner CA, Cortese MM, Patel MM, Parashar UD. Trends in intussusception hospitalizations among US infants before and after implementation of the rotavirus vaccination program, 2000-2009. J Infect Dis 2012;206:41-8. https://doi.org/10.1093/infdis/jis314
  20. Blanch AJ, Perel SB, Acworth JP. Paediatric intussusception: epidemiology and outcome. Emerg Med Australas 2007;19:45-50. https://doi.org/10.1111/j.1742-6723.2007.00923.x
  21. Rice-Townsend S, Chen C, Barnes JN, Rangel SJ. Variation in practice patterns and resource utilization surrounding management of intussusception at freestanding Children's Hospitals. J Pediatr Surg 2013;48:104-10. https://doi.org/10.1016/j.jpedsurg.2012.10.025
  22. Gray MP, Li SH, Hoffmann RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics 2014;134:110-9. https://doi.org/10.1542/peds.2013-3102
  23. Amuddhu SK, Chen Y, Nah SA. Inpatient admission versus emergency department management of intussusception in children: a systemic review and meta-analysis of outcomes. Eur J Pediatr Surg 2019;29:7-13. https://doi.org/10.1055/s-0038-1668145
  24. Litz CN, Amankwah EK, Polo RL, Sakmar KA, Danielson PD, Chandler NM. Outpatient management of intussusception: a systematic review and meta-analysis. J Pediatr Surg 2019;54:1316-23. https://doi.org/10.1016/j.jpedsurg.2018.09.019
  25. Cho MJ, Nam CW, Choi SH, Hwang EH. Management of recurrent ileocolic intussusception. J Pediatr Surg 2019. doi: 10.1016/j.jpedsurg.2019.09.039. [Epub ahead of print].
  26. Ma GMY, Lillehei C, Callahan MJ. Air contrast enema reduction of single and recurrent ileocolic intussusceptions in children: patterns, management and outcomes. Pediatr Radiol 2020;50:664-72. https://doi.org/10.1007/s00247-020-04612-5
  27. Daneman A, Alton DJ, Lobo E, Gravett J, Kim P, Ein SH. Patterns of recurrence of intussusception in children: a 17-year review. Pediatr Radiol 1998;28:913-9. https://doi.org/10.1007/s002470050497
  28. Savoie KB, Thomas F, Nouer SS, Langham MR Jr, Huang EY. Age at presentation and management of pediatric intussusception: a Pediatric Health Information System database study. Surgery 2017;161:995-1003. https://doi.org/10.1016/j.surg.2016.09.030
  29. Hsiao CC, Tsao LY, Lai CH. Nationwide population-based epidemiologic study of childhood and adulthood intussusception in Taiwan. Pediatr Neonatol 2013;54:188-93. https://doi.org/10.1016/j.pedneo.2013.01.004
  30. Hsu WL, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, et al. Recurrent intussusception: when should surgical intervention be performed? Pediatr Neonatol 2012;53:300-3. https://doi.org/10.1016/j.pedneo.2012.07.004
  31. Wayne ER, Campbell JB, Kosloske AM, Burrington JD. Intussusception in the older child- suspect lymphosarcoma. J Pediatr Surg 1976;11:789-94. https://doi.org/10.1016/0022-3468(76)90104-4
  32. Lopez Alvarez-Buhilla P, Idigoras G, Torres C, Larrea F, Bezanilla JL. [Non-Hodgkin's lymphoma as a cause of intussusception in children]. An Esp Pediatr 1987;27:467-70. Spanish.
  33. Boudville IC, Phua KB, Quak SH, Lee BW, Han HH, Verstraeten T, et al. The epidemiology of paediatric intussusception in Singapore: 1997 to 2004. Ann Acad Med Singapore 2006;35:674-9.
  34. Awasthi S, Agarwal GG, Mishra V, Nag VL, El Sayed HF, da Cunha AJ, et al. Four-country surveillance of intestinal intussusception and diarrhoea in children. J Paediatr Child Health 2009;45:82-6. https://doi.org/10.1111/j.1440-1754.2008.01434.x
  35. Kombo LA, Gerber MA, Pickering LK, Atreya CD, Breiman RF. Intussusception, infection, and immunization: summary of a workshop on rotavirus. Pediatrics 2001;108:E37. https://doi.org/10.1542/peds.108.2.e37
  36. Rennels MB, Parashar UD, Holman RC, Le CT, Chang HG, Glass RI. Lack of an apparent association between intussusception and wild or vaccine rotavirus infection. Pediatr Infect Dis J 1998;17:924-5. https://doi.org/10.1097/00006454-199810000-00018
  37. Lappalainen S, Ylitalo S, Arola A, Halkosalo A, Rasanen S, Vesikari T. Simultaneous presence of human herpesvirus 6 and adenovirus infections in intestinal intussusception of young children. Acta Paediatr 2012;101:663-70. https://doi.org/10.1111/j.1651-2227.2012.02616.x
  38. Cortese MM, Staat MA, Weinberg GA, Edwards K, Rice MA, Szilagyi PG, et al. Underestimates of intussusception rates among US infants based on inpatient discharge data: implications for monitoring the safety of rotavirus vaccines. J Infect Dis 2009;200 Suppl 1:S264-70. https://doi.org/10.1086/605055
  39. Kohl LJ, Streng A, Grote V, Koletzko S, Liese JG. Intussusception-associated hospitalisations in southern Germany. Eur J Pediatr 2010;169:1487-93. https://doi.org/10.1007/s00431-010-1248-x

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