Stringer M D, Pledger G, Drake D P
Hospitals for Sick Children, London.
BMJ. 1992 Mar 21;304(6829):737-9. doi: 10.1136/bmj.304.6829.737.
To assess the incidence of potentially avoidable factors contributing to death of children with intussusception.
Review of children who died with intussusception in England and Wales between 1984 and 1989 from data of the Office of Population Censuses and Surveys, case notes, coroners' records, and necropsy reports.
Unambiguous objective criteria such as failure to diagnose intussusception within 24 hours of admission.
33 children died of acute intussusception in England and Wales between 1984 and 1989 compared with 67 in the previous six years. Their median age was 7 months (range 2 months to 12 years), and two thirds were boys. Half of the deaths occurred at home or soon after arrival at hospital but 15 patients had surgery. Potentially avoidable factors contributing to death were identified in 20 (61%) children, all but three of whom had ileocolic intussusception. These factors were excessive delay in diagnosis, inadequate intravenous fluid and antibiotic therapy, delay in recognising recurrent or residual intussusception after hydrostatic reduction, and surgical complications. Of the 13 patients in whom no avoidable factors were identified, there were nine of 11 children with isolated small bowel intussusception, who tended to have atypical presentations.
Although the mortality from intussusception has declined, there remains ample opportunity for improved management.
评估导致肠套叠患儿死亡的潜在可避免因素的发生率。
根据人口普查与调查办公室的数据、病历、验尸官记录及尸检报告，对1984年至1989年间在英格兰和威尔士死于肠套叠的儿童进行回顾性研究。
明确的客观标准，如入院24小时内未诊断出肠套叠。
1984年至1989年间，英格兰和威尔士有33名儿童死于急性肠套叠，而前六年为67名。他们的中位年龄为7个月（范围2个月至12岁），三分之二为男孩。半数死亡发生在家中或入院后不久，但有15名患者接受了手术。在20名（61%）儿童中发现了导致死亡的潜在可避免因素，除3名外，其余均为回结肠型肠套叠。这些因素包括诊断过度延迟、静脉补液和抗生素治疗不足、水压复位后对复发性或残留性肠套叠认识延迟以及手术并发症。在未发现可避免因素的13名患者中，11名孤立性小肠套叠患儿中有9名，他们往往表现不典型。
尽管肠套叠的死亡率有所下降，但仍有很大的改进管理的空间。
