61 Analgesia and sedation for pediatric ileocolic intussusception: a global, multicenter, cross-sectional study (PAINT)
Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".