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Institution: Starship Children's Hospital - Auckland, Aotearoa New Zealand
Purpose: Most children with intussusception are successfully managed with radiologic enema reduction. Our recent nationwide study revealed significant interhospital variation in the rates of enema reduction success and recurrence. We hypothesise this could be due to differences in management. Therefore we sought to investigate radiologic enema management patterns across Aotearoa New Zealand (AoNZ).
Methodology: We performed a snapshot survey of all radiologists who manage paediatric intussusception. Survey answers were collected anonymously via REDCap between 01 Apr 2023 - 01 Jul 2023. Network sampling was used to attain saturation.
Results: In total, 24 of the 26 radiologists who regularly manage paediatric intussusception responded. An institutional management guideline was reported in 88% of cases. Pneumatic reduction via Foley catheter under fluoroscopic guidance was used preferentially in 23 cases (96%). A range of catheter retention strategies and hardware were documented. There was significant variation in reported initial and peak reduction pressures, from 0-120mmHg and 100-130mmHg, respectively. If partially successful, another attempt was repeated after 0-5 minutes with a maximum of 3-8 attempts in one sitting. Reduction was most commonly confirmed through small bowel insufflation (92%), but seven clinicians utilised postreduction ultrasound (29%).
Conclusion: Almost all AoNZ centres relied on pneumatic reduction under fluoroscopic guidance. Hydrostatic reduction and ultrasound were rarely utilised. Beyond this, pressure limits, reduction attempt timing and periprocedural care appeared to vary significantly. These data lend support for a multidisciplinary standardised, national approach to this common disease.
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Dr Brodie Elliott - , Dr Shona Naera - , Dr Jonathan Wells - , Dr Christopher Cassady - , Dr Stephen Evans -