Epidemiology of intussusception in children : national surveillance and use of record linkage to validate the incidence, and study of incidence trends

• Main Author: Samad, L.
• Other Authors: Taylor, B. ; El Bashir, H.
• Published: University College London (University of London) 2014
• Subjects: 618.92
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.631897

Introduction: Intussusception (IS), an abdominal emergency in young children, has been linked to rotavirus vaccines used to prevent rotavirus gastroenteritis. We aimed to determine the pre-vaccination incidence of IS among infants in the United Kingdom (UK) and Republic of Ireland (ROI) in 2008-2009. IS incidence trends in children aged < 16 years were estimated for England, 1995-2009. Methods: The established BPSU system was used to estimate the IS incidence (recorded per 100,000 live births) among infants in the UK and ROI using the standard Brighton Collaboration case definition. Incidence rates for England were validated by record linkage between the BPSU and Hospital Episode Statistics (HES) datasets (2008-2009). The completeness of BPSU and HES data was calculated using capture-recapture methodology. IS incidence trends were estimated for England using HES. Results: The annual (BPSU) IS incidence in infants was 24.8 (95% CI: 21.7-28.2) in the UK and 24.2 (95% CI: 15.0-37.0) in ROI. UK rates varied: from 40.6 (95% CI: 21.0-71.8) in Northern Ireland, to Scotland (28.7, 95% CI: 17.5-44.3), then England (24.2, 95% CI: 20.9-27.9) and Wales (16.9, 95% CI: 6.8-34.8). Record linkage increased the incidence among infants from 24.2 (95% CI: 20.9-27.9) to 28.9 (95% CI: 25.3-33.0). The completeness of BPSU reporting was 81.5% compared to 85.8% for HES. A decline in IS incidence was observed from 1995 to 2009, predominantly for infants, with significantly higher (p=0.001) rates in winter and spring for both BPSU and HES data. Present clinical management of IS in the UK and ROI is associated with a higher than expected rate of surgical intervention and a lower rate of successful air-enema reduction than in other similar countries. Conclusions: National (and ROI) pre-vaccination incidence rates of IS are now available to inform post-marketing rotavirus vaccine surveillance. The present findings should improve the future epidemiological assessment of IS.