Rosenfeld K, McHugh K
Radiology Department, Great Ormond Street Hospital for Children, London, UK.
Clin Radiol. 1999 Jul;54(7):452-8. doi: 10.1016/s0009-9260(99)90831-0.
The aim of our study was to assess the variation in technique among hospitals in England, Wales and Scotland. In addition, local in hospital variation among paediatric radiologists at our own institution was assessed.
Postal questionnaires were distributed to the radiology departments of 301 hospitals.
183 (60.8%) replies were received. 122 institutions reduced intussusceptions and 61 did not. A lack of paediatric surgical and/or anaesthetic cover, and a lack of radiological experience were the major reasons cited by the departments which did not attempt intussusception reduction. Sixty-five hospitals use barium for hydrostatic reduction, 43 employ pneumatic reduction, 10 use water-soluble enemas and four use ultrasound. Of the 65 centres using barium 16 (25%) reported a success rate of less than 50%, 24 (37%) had a 50-70% success rate, seven (11%) reduce greater than 70% of intussusceptions and 18 (27%) did not know. In the 43 institutions employing air reduction, one (2%) had a success rate less than 50%, 20 (47%) had a 50-70% success rate, 17 (40%) a success rate greater than 70% and five (11%) did not know. Overall, of the total number of hospitals which replied to our survey, 28 (23%) reported that they were not aware of their success rates. Within the pneumatic reduction group in particular there was marked variation in the methods and duration of attempted reduction - between different hospitals and within the same institution. In six departments the machine used for pneumatic reduction did not measure intraluminal pressure.
Ultrasound is underutilized despite being a sensitive method in diagnosis. There is almost certainly an over-reliance on plain radiographs and on the use of sedation, antibiotics and anti-spasmodics in general. We believe a 70% or greater success rate should be achievable in most institutions whether by pneumatic or hydrostatic reduction, and all departments should strive to achieve success rates in this range. Less than a quarter of centres who replied currently achieve this standard. Successful reduction rates below 50% are unacceptable in our opinion. Not surprisingly, success rates are generally highest in those centres treating more than 20 cases per annum. Twenty-eight (23%) of hospitals performing intussusception reductions did not know their success rates. Regular audits of intussesception figures should take place in all institutions. Unacceptably wide variations in intussusception reduction techniques currently exist. An accurate pressure release valve at least, and preferably intraluminal pressure monitoring should be an integral component of all pneumatic reduction devices. The British Paediatric Radiology and Imaging Group or the Royal College of Radiology should address these issues and introduce some standardization of practice.
我们研究的目的是评估英格兰、威尔士和苏格兰各医院之间技术上的差异。此外，还评估了我们所在机构的儿科放射科医生在医院内部的差异。
向301家医院的放射科发放了邮政调查问卷。
共收到183份（60.8%）回复。122家机构进行了肠套叠复位，61家未进行。未尝试肠套叠复位的科室提到的主要原因是缺乏小儿外科和/或麻醉支持以及缺乏放射学经验。65家医院使用钡剂进行水压复位，43家采用气压复位，10家使用水溶性灌肠剂，4家使用超声。在使用钡剂的65个中心中，16家（25%）报告成功率低于50%，24家（37%）成功率为50 - 70%，7家（11%）复位超过70%的肠套叠，18家（27%）不清楚。在采用空气复位的43家机构中，1家（2%）成功率低于50%，20家（47%）成功率为50 - 70%，17家（40%）成功率高于70%，5家（11%）不清楚。总体而言，在回复我们调查的医院总数中，28家（23%）报告他们不知道自己的成功率。特别是在气压复位组中，不同医院之间以及同一机构内部在尝试复位的方法和持续时间上存在明显差异。在6个科室中，用于气压复位的机器未测量腔内压力。
超声尽管在诊断中是一种敏感方法，但未得到充分利用。几乎可以肯定，普遍过度依赖平片以及镇静剂、抗生素和抗痉挛药的使用。我们认为，大多数机构无论是通过气压复位还是水压复位，都应能达到70%或更高的成功率，所有科室都应努力达到这一成功率范围。回复的中心中目前只有不到四分之一达到了这一标准。我们认为成功率低于50%是不可接受的。不出所料，每年治疗超过20例病例的中心成功率通常最高。进行肠套叠复位的医院中有28家（23%）不知道自己的成功率。所有机构都应定期审核肠套叠数据。目前肠套叠复位技术存在不可接受的广泛差异。至少一个精确的压力释放阀，最好是腔内压力监测，应成为所有气压复位设备的一个组成部分。英国儿科放射学与影像学组或皇家放射学院应解决这些问题并引入一些实践标准化。
