Opioid Administration and Reduction of Pediatric Ileocolic Intussusception
Notice bibliographique
Résumé
Importance: Ileocolic intussusception is an important and painful cause of bowel obstruction in children. Its reduction is also painful, but neither sedation nor analgesia is routinely provided, in part due to concerns surrounding gastrointestinal slowing and consequent failed reduction, and while fentanyl is a potent analgesic, little is known about its association with failed reduction. Objective: To investigate whether fentanyl is associated with failed reduction in children with intussusception. Design, Setting, and Participants: This was a secondary analysis of a cross-sectional study from 86 pediatric tertiary care centers in 14 countries conducted between January 1, 2017, and December 31, 2019, characterizing the association of opioid analgesia and sedation with intestinal perforation and failed reduction in children. A consecutive sample of patients 4 to 48 months of age with a discharge diagnosis of ileocolic intussusception who underwent an attempted reduction of intussusception was analyzed, excluding repeat presentations of intussusception and records lacking data for the primary outcome. Main Outcome and Measures: Age, sex, preexisting gastrointestinal anomalies, time to reduction, and use of prereduction opioid medication data were collected. The primary outcome was the percentage of patients with failed reduction of ileocolic intussusception. Bivariate and multivariable analyses were conducted to determine the association between fentanyl and failed reduction. Data were analyzed in February 2025. Results: In total, 3184 patients (2038 [64.01%] male), with a median (IQR) age of 17 (9-27) months, were included. Fentanyl was administered within 120 minutes of attempted reduction for 116 of 3167 patients (3.66%). Failed reduction occurred in 484 of 3184 patients (15.20%). In the unadjusted analysis, fentanyl was not associated with failed reduction (odds ratio [OR], 0.66 [95% CI, 0.36-1.22]). In the adjusted analysis, preexisting gastrointestinal anomalies (OR, 4.38 [95% CI, 1.50-12.76]), longer triage to reduction time (OR, 1.04 [95% CI, 1.01-1.07]), and younger age (OR, 0.96 [95% CI, 0.95-0.97]) were associated with failed reduction. Conclusions and Relevance: In this cross-sectional study of pediatric ileocolic intussusception, fentanyl administration prior to attempted reduction was not associated with failed reduction. These results suggest that fentanyl may be considered a safe therapeutic option to manage children's intussusception and subsequent reduction-related pain.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 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 tête enseignante, 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 ».