Opioid Administration and Reduction of Pediatric Ileocolic Intussusception
Bibliographic record
Abstract
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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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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".