Determining factors of clinical outcomes in paediatric intussusception at Johannesburg hospital

Abstract

Aim: The aim of this research report is to assess which local epidemiological and clinical factors determine impact on the morbidity and mortality of intussusception, expressed as defined clinical outcomes. Methods: A retrospective hospital record review of paediatric intussusception admitted to Chris Hani Baragwanath (CHBH) and Charlotte Maxeke Johannesburg Academic Hospitals (CMJAH) for the period of January 2007 to April 2010 was undertaken. The four determining factors evaluated are: Duration of symptoms, weight, palpable rectal intussusceptum, admission serum C-­‐reactive protein, against seven possible clinical outcomes: Failed pneumatic reduction, perforation during attempted pneumatic reduction, intestinal resection, ileostomy, relook laparotomy, intensive care unit admission and mortality. A total of 108 cases were found of which 11 were excluded from data analysis. Results: Sixty eight percent of cases were from CHBH and a total of 57% of cases were referred from surrounding medical facilities. 62 of 97 cases had an attempted pneumatic reduction with a 51.6% (32/62) success rate and an overall success rate of 32/97, 33%. Seven cases developed pneumoperitoneum during pneumatic reduction. A total of 65 cases underwent surgical management. Of those 81.5% (53/65) underwent intestinal resection. Ileostomy diversion was necessary in 13.8% (9/65) of operative cases and 11% (7/65) needed a second surgical procedure during the initial presenting admission. An overall mortality rate of 9.3% (9/97) is noted. Conclusion: Intussusception in Johannesburg is associated with significant morbidity and mortality. Duration of symptoms and C -­‐ reactive protein levels are predictive for clinical outcomes in paediatric intussusception.