Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Am J Emerg Med. 2012 Oct;30(8):1501-6. doi: 10.1016/j.ajem.2011.12.014. Epub 2012 Feb 4.
Gastrostomy tube (g-tube) dislodgement is a common problem in special needs children. There are no studies on the frequency of complications after g-tube replacement for children in a pediatric emergency department (ED).
The objective of this study is to determine the frequency of misplacement and subsequent complications for children undergoing g-tube replacement in a pediatric ED and the impact of contrast-enhanced confirmatory imaging on ED length of stay (LOS).
This was a retrospective review of children presenting to a pediatric ED over 16 months. Subjects were included if they underwent g-tube replacement in the ED. Records were reviewed for historical and procedural data including patient age, g-tube age, ED LOS, documented difficulties replacing the tube, performance of confirmatory imaging (contrast-enhanced radiograph), and complications identified within 72 hours of ED visit.
A total of 237 children met inclusion criteria. Three (1.2%) had evidence of g-tube misplacement, all of whom underwent confirmatory imaging. One complication from misplacement was identified (gastric outlet obstruction from overfilled balloon). Tract disruption was not identified for any subject. Eighty-four subjects (35%) had confirmatory imaging performed after replacement. Mean ED LOS in the imaged group was 265 vs 142 minutes for the nonimaged group (P < .001). No subjects with documentation of clinical confirmation had subsequent evidence of misplacement.
For children undergoing g-tube replacement in a pediatric ED, misplacement and associated complications were rare. Confirmatory imaging was associated with a considerably longer LOS. In the presence of clinical confirmation, confirmatory imaging may be judiciously used.
胃造口管（g-tube）移位是特殊需求儿童中常见的问题。在儿科急诊部（ED），尚无关于儿童更换 g-tube 后并发症频率的研究。
本研究旨在确定儿科 ED 中更换 g-tube 的儿童发生 g-tube 错位和随后并发症的频率，以及对比增强确认性成像对 ED 住院时间（LOS）的影响。
这是一项对儿科 ED 就诊的 16 个月内的儿童进行的回顾性研究。如果在 ED 中更换 g-tube，则纳入受试者。记录回顾了包括患者年龄、g-tube 年龄、ED LOS、记录更换管的困难、进行确认性成像（对比增强射线照相）以及 ED 就诊后 72 小时内发现的并发症在内的病史和程序数据。
共有 237 名儿童符合纳入标准。3 名（1.2%）有 g-tube 错位的证据，所有这些患者都进行了确认性成像。发现了 1 例错位并发症（因球囊过度充盈导致胃出口梗阻）。没有受试者出现管腔破裂。84 名受试者（35%）在更换后进行了确认性成像。成像组的平均 ED LOS 为 265 分钟，而未成像组为 142 分钟（P<0.001）。没有记录临床确认的受试者随后有错位的证据。
在儿科 ED 中接受 g-tube 更换的儿童中，错位和相关并发症很少见。确认性成像与较长的 LOS 有关。在存在临床确认的情况下，确认性成像可以谨慎使用。
