61 Analgesia and sedation for pediatric ileocolic intussusception: a global, multicenter, cross-sectional study (PAINT)
Notice bibliographique
Résumé
Abstract Background Ileocolic intussusception requires timely reduction to prevent complications. Reduction can be distressing. Sedation is uncommon due to controversial beliefs surrounding an increased risk of perforation. Analgesia and sedation practices for children undergoing reduction of intussusception remain largely unknown. Objectives To characterize global practice patterns of analgesia and sedation for reduction of intussusception. Design/Methods We conducted a global, cross-sectional study involving 84 centres in 14 countries. We included children 4 to 48 months with a sonographic or radiographic diagnosis of ileocolic intussusception and attempted reduction between January 1, 2017, and December 31, 2019. The primary and secondary outcomes were analgesia and sedation, respectively, prior to reduction. An a priori explanatory analysis was performed to explore the association of sedation with (i) adverse events, (ii) perforation, and (iii) failed reduction. Results We included 3203 children [2054/3203 (64.1%)] males, with median (IQR) age of 17 (9,27) months. Suspected abdominal pain was present in 2283/3187 (71.6%) children. At triage, a pain assessment tool was documented in 1859/3112 (59.7%) and analgesia was administered to 305/3171 (9.6%) children. After triage, pain was reassessed in 1448/3169 (45.7%) and analgesia was administered to 552/3158 (17.5%) children. Prior to reduction, 550/3161 (17.4%) children were sedated. Non-opioid and opioid analgesia were administered to 183/2945 (6.2%) and 560/3134 (17.9%), respectively. Reduction was performed using air enema in 2372/3184 (74.5%) children and 2700/3184 (84.8%) of all reductions were successful. Reduction related adverse events [65/3166 (2.1%)] were reported in 59 patients, most commonly vomiting [31/3166 (1.0%)] and perforation [13/3166 (0.4%)]. In the bivariate analyses, sedation was not associated with an increased odds of adverse events [OR: 1.1; 95% CI: 0.6-2.1; p=0.79] or perforation [OR: 2.1; 95% CI: 0.7-6.9; p=0.21]. Sedation was associated with an increased odds of failed reduction [OR: 1.4; 95% CI: 1.1-1.7; p=0.01], but this became non-significant in the multivariable analysis [OR: 1.1; 95% CI: 0.8-1.6; p=0.53] after adjusting for age and premorbid gastrointestinal anomaly. Conclusion Although more than 2/3 of children with intussusception present with pain, less than 10% were administered analgesia at triage. Prior to reduction, analgesia or sedation was administered to less than 1/5 of children. Adverse events, including perforation were uncommon. Sedation was not associated with adverse events or an increased odds of failed reduction in the adjusted analysis. Our findings suggest that analgesia should be considered in children with suspected abdominal pain and sedation should be routinely considered for children undergoing reduction of intussusception.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».