How does the Canadian Acute Respiratory Illness and Flu Scale relate to other scales in pediatric asthma exacerbations?

OBJECTIVES: In children with asthma exacerbations, we evaluated the relationship between Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores and (a) Asthma Diary Scale (ADS) scores for 14 days; (b) Pediatric Asthma Caregiver's Quality of Life (QoL) Questionnaire (PACQLQ) scores on days 1, 7 and 14; (c) viral detection. We hypothesized that in children with acute asthma, CARIFS scores correlate with ADS and PACQLQ scores over time and that viruses have little impact on CARIFS scores. METHODS: In children aged 2-16 years who presented with acute asthma to the Emergency Departments of 2 hospitals, we documented the clinical history, examination, asthma severity at baseline and on presentation. Eighteen respiratory pathogens were determined by PCR on nasopharyngeal aspirate (NPA) collected on recruitment. The parent(s) recorded their child's daily CARIFS and ADS and weekly PACQLQ for 14 days. We used Spearman's correlation to relate the scores of 108 children. RESULTS: CARIFS scores correlated well with ADS scores throughout 14 days (rs ranged 0.30-0.67). CARIFS and PACQLQ scores correlated -0.28, -0.14 and -0.44 on days 1, 7 and 14 respectively. There was no significant difference in CARIFS scores between children whose NPAs were PCR virus-positive or -negative over 14 days. CONCLUSIONS: CARIFS and ADS scores correlated well as a disease severity measure during the recovery period in children with acute asthma and this was not influenced by the virus state. The ADS may be used as an alternative in selected situations. The CARIFS reflects different aspects to acute asthma severity and QoL.

Determinants of cough and caregivers' quality of life in pediatric asthma exacerbations.

OBJECTIVES: In hospitalized and nonhospitalized children with asthma exacerbations, we evaluated the determinants of (a) prolonged cough on day-14 and (b) asthma quality of life (QoL) questionnaires for parents (PACQLQ) on day-21. We hypothesized that children with more severe acute asthma are more likely to have prolonged cough and/or poorer PACQLQ during the recovery phase. DESIGN: Prospective cohort study performed during 2009-2011. METHODOLOGY: Two hundred and forty-four children aged 2-16 years presenting with acute asthma to the Emergency Departments of two hospitals were recruited. Clinical history, examination, baseline asthma severity, and acute asthma severity on presentation were documented. Validated daily cough diaries and weekly PACQLQ were recorded for 14 and 21 days, respectively. RESULTS: 34.4% and 32.2% of children who returned the daytime and nighttime cough diaries respectively had a prolonged cough. Those on regular inhaled corticosteroids (ICS) were significantly more likely to have a daytime or nighttime cough score of ≥1 on day-14 (odds ratio [ORadjusted ] = 4.70, 95% confidence interval [CI] 1.65, 13.35, p = .004 and ORadjusted = 2.65, 95% CI 1.05, 6.69, p = .040, respectively). PACQLQ on day-21 was significantly poorer in younger children (mean difference [MD] = -0.04 per year, 95% CI -0.08, -0.01, p = .016), those on ICS (MD = -0.31, 95% CI -0.52, -0.09, p = .005), leukotriene antagonists (MD = -0.42, 95% CI -0.83, -0.02, p = .040) and in those who had an unplanned visit for asthma on day-21 (MD = -1.20, 95% CI -1.61, -0.78, p = .0001). CONCLUSIONS: Post an acute asthma exacerbation, children on regular ICS were more likely to have prolonged cough and poorer QoL. While this may be reflective of asthma severity or control, its association deserves further evaluation.

Burden and emergency department management of acute cough in children.

AIM: In children presenting to an emergency department (ED) with an acute coughing illness, the aims of this study were to: (i) describe the frequency of doctor visits and medication use; and (ii) describe management and relate it to current evidence-based guidelines. METHODS: This was a cross-sectional study in ED of a major teaching hospital (Royal Children's Hospital, Brisbane, Australia). Participants included 537 children (<15 years) presenting with acute (<2 weeks) cough, with a median age of 2.2 years (interquartile range 1.0-4.0); 61.5% were boys. Hospitalised children and those with asthma, pneumonia or chronic illnesses were excluded. Main outcome measures were: (i) frequency of pre-ED doctor visits and medication use; and (ii) comparison of management to current evidence-based recommendations related to four discharge diagnoses: bronchiolitis, 'wheeze/reactive airway disease (RAD)', croup and 'non-specific acute respiratory illness'. RESULTS: A total of 300 children (55.9%) had seen a doctor prior to their ED presentation, and use of medications pre-ED was high (53.4%). While 93.4% of children with croup were treated in accordance with guidelines, concordance was lower for children with bronchiolitis or 'wheeze/RAD'. The majority of children with a discharge diagnosis of 'wheeze/RAD' (95.6%) received bronchodilators, and 72.7% also received oral corticosteroids but were not diagnosed with asthma. More than half (55.1%) of the children with non-specific acute respiratory illness received medication(s) either prior to or during their ED presentation. CONCLUSIONS: The burden of acute cough-related illnesses in children is high, and there is a need for improved uptake of evidence-based guidelines. In addition, the large number of children diagnosed with 'wheeze/RAD' suggests asthma is likely under-diagnosed in this setting.

Presence of atopy increases the risk of asthma relapse.

OBJECTIVES: To describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations. DESIGN: This was a prospective study performed during 2009-2011. SETTING: The study was performed in the emergency departments of two hospitals. PATIENTS: 244 children aged 2-16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed. MAIN OUTCOME MEASURES: The outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days). RESULTS: PCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). Mycoplasma pneumoniae and Chlamydophila pneumoniae were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23). CONCLUSIONS: The presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. M. pneumoniae and C. pneumoniae are rare triggers of acute asthma in young children.

Upper airway viruses and bacteria and clinical outcomes in children with cough.

BACKGROUND: Cough is symptomatic of a broad range of acute and chronic pediatric respiratory illnesses. No studies in children have tested for an extended panel of upper airway respiratory viruses and bacteria to identify whether they predict cough outcomes, irrespective of clinical diagnosis at the time of acute respiratory illness (ARI). We therefore determined whether upper airway microbes independently predicted hospitalization and persistent cough 28-days later in children presenting with an ARI, including cough as a symptom. METHODS: A cohort study of children aged <15-years were followed for 28-days after presenting to a pediatric emergency department with an ARI where cough was also a symptom. Socio-demographic factors, presenting clinical features and a bilateral anterior nasal swab were collected at enrolment. Polymerase chain reaction assays tested for seven respiratory bacteria and 17 viruses. Predictors of hospitalization and persistent cough at day-28 were evaluated in logistic regression models. RESULTS: Eight hundred and seventeen children were included in the analysis; median age 27.7-months. 116 (14.2%, 95%CI 11.8, 16.6) children were hospitalized and 163 (20.0%, 95%CI 17.2, 22.7) had persistent cough at day-28. Hospitalized children were more likely to have RSV A or B detected on nasal swab than those not admitted (adjusted relative risk (aRR) 1.8, 95%CI 1.0, 3.3). M. catarrhalis was the only microbial difference between children with and without cough persistence (aRR for those with cough at day 28: 2.1, 95%CI 1.3, 3.1). DISCUSSION: An etiologic role for M. catarrhalis in the pathogenesis of persistent cough post-ARI is worth exploring, especially given the burden of chronic cough in children and its relationship with chronic lung disease. Pediatr Pulmonol. 2017;52:373-381. © 2016 Wiley Periodicals, Inc.

An acute cough-specific quality-of-life questionnaire for children: Development and validation.

BACKGROUND: Patient-relevant outcome measures are essential for high-quality clinical research, and quality-of-life (QoL) tools are the current standard. Currently, there is no validated children's acute cough-specific QoL questionnaire. OBJECTIVE: The objective of this study was to develop and validate the Parent-proxy Children's Acute Cough-specific QoL Questionnaire (PAC-QoL). METHODS: Using focus groups, a 48-item PAC-QoL questionnaire was developed and later reduced to 16 items by using the clinical impact method. Parents of children with a current acute cough (<2 weeks) at enrollment completed 2 validated cough score measures, the preliminary 48-item PAC-QoL, and 3 other questionnaires (the State Trait Anxiety Inventory [STAI], the Short-Form 8-item 24-hour recall Health Survey [SF-8], and the Depression, Anxiety, and Stress 21-item Scale [DASS21]). All measures were repeated on days 3 and 14. RESULTS: The median age of the 155 children enrolled was 2.3 years (interquartile range, 1.3-4.6). Median cough duration at enrollment was 3 days (interquartile range, 2-5). The reduced 16-item scale had high internal consistency (Cronbach α = 0.95). Evidence for repeatability and criterion validity was shown by significant correlations between the domains and total PAC-QoL scores and the SF-8 (r = -0.36 and -0.51), STAI (r = -0.27 and -0.39), and DASS21 (r = -0.32 and -0.41) scales on days 0 and 3, respectively. The final PAC-QoL questionnaire was sensitive to change over time, with changes significantly relating to changes in cough score measures (P < .001). CONCLUSION: The 16-item PAC-QoL is a reliable and valid outcome measure that assesses QoL related to childhood acute cough at a given time point and reflects changes in acute cough-specific QoL over time.

Inhaled corticosteroids for subacute cough in children.

BACKGROUND: Cough is the most common symptom presenting to primary healthcare services. Cough in children is associated with significant morbidity for both children and their parents. While inhaled corticosteroids (ICS) can potentially reduce cough associated with airway inflammation and airway hyper-reactivity, use of ICS in children is not without potential adverse effects. Therefore, it would be beneficial to clinical practice to evaluate the evidence for the efficacy of ICS in reducing the severity of cough in children with subacute cough (defined as cough duration of two to four weeks) systematically. OBJECTIVES: To evaluate the efficacy of ICS in reducing the severity of cough in children with subacute cough. SEARCH METHODS: The Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The latest searches were performed in November 2011. SELECTION CRITERIA: All randomised controlled trials (RCTs) comparing ICS with a control group in children with subacute cough were considered for inclusion. DATA COLLECTION AND ANALYSIS: Search results were reviewed against pre-determined criteria for inclusion. Two sets of review authors independently selected, extracted and assessed the data for inclusion. Study authors were contacted for further information where required. Data were analysed as 'intention to treat'. MAIN RESULTS: The search identified 1178 potentially relevant titles; however, there were no published studies that were specifically designed to answer this question. Two studies met criteria for inclusion in the review and 98 children were included in the meta-analysis. There was no significant difference between groups in the proportion of children 'not cured' at follow-up (primary outcome measure), with a pooled odds ratio (OR) of 0.61 (95% confidence interval (CI) 0.24 to 1.55). However, the included studies were limited in their ability to answer the review question by the fact that all participants were infants, post acute bronchiolitis illness, and cough duration at the start of study medication was ill-defined. AUTHORS' CONCLUSIONS: There is currently no evidence to support the use of ICS for treatment of subacute cough in children. However, this systematic review is limited by the small number of studies available for analysis and the size, quality and design of these studies. Further well-designed RCTs are required to support or refute the efficacy of treatment with ICS in children with subacute cough.

Anticholinergic therapy for acute asthma in children.

BACKGROUND: Inhaled anticholinergics as single agent bronchodilators (or in combination with beta(2)-agonists) are one of the several medications available for the treatment of acute asthma in children. OBJECTIVES: To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma. SEARCH METHODS: The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011. SELECTION CRITERIA: We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials, extracted data and assessed trial quality. MAIN RESULTS: Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta(2)-agonists from four trials on 171 children (odds ratio (OR) 2.27; 95% CI 1.08 to 4.75). Also, treatment failure on anticholinergics alone was more likely than when anticholinergics were combined with beta(2)-agonists from four trials on 173 children (OR 2.65; 95% CI 1.2 to 5.88). Data on clinical scores/symptoms that were measured on different scales were conflicting. Individual trials reported that lung function was superior in the combination group when compared with anticholinergic agents used alone. The use of anticholinergics was not found to be associated with significant side effects. AUTHORS' CONCLUSIONS: In children over the age of two years with acute asthma exacerbations, inhaled anticholinergics as single agent bronchodilators were less efficacious than beta(2)-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta(2)-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.

Treatment of obstructive sleep apnoea for chronic cough in children.

BACKGROUND: Childhood obstructive sleep apnoea (OSA) is a disorder that is characterised by repeated episodes of partial or complete upper airway obstruction (UAO) during sleep that result in disruption of normal ventilation and sleep patterns. Chronic cough in children is a significant medical problem and in some situations warrants thorough investigation. There may be an association between chronic cough and OSA as suggested in adult studies. OBJECTIVES: To evaluate the efficacy of treatment of OSA leading to the resolution of cough in the management of children with chronic cough. SEARCH STRATEGY: We searched the Cochrane Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE and EMBASE. The latest search was performed in September 2010. SELECTION CRITERIA: All randomised controlled trials comparing an intervention for OSA to a control group (placebo or usual treatment) in children with chronic cough. DATA COLLECTION AND ANALYSIS: We reviewed the search results against the pre-determined criteria for inclusion. Two review authors independently selected the studies. No eligible trials were identified and thus no data were available for analysis. MAIN RESULTS: We found no randomised controlled trials that examined the efficacy of treatment of OSA in the management of children with chronic cough. AUTHORS' CONCLUSIONS: There is currently no evidence that therapies directed for OSA are useful for the management of chronic cough in children. Until further evidence is available, OSA should be managed on its own merits and the presence or absence of cough should not be used as a decision trigger. Further research examining the effects of this intervention is needed.

Pyloric stenosis: a retrospective study of an Australian population.

Increased awareness of idiopathic hypertrophic pyloric stenosis (IHPS) and readily available ultrasonographic diagnosis might mean that 'classic' presentations are becoming less common. We sought to describe the epidemiology, clinical features and outcomes of children with IHPS in the modern era. A retrospective case review of all cases of IHPS presenting to a single tertiary paediatric hospital over an 11 year period was conducted. Inclusion criteria were met by 329 children with confirmed IHPS. Eighty-four per cent of patients were male and 19% were born premature. Premature infants tended to present later, reflecting postmenstrual age. The median age at presentation was 5 weeks (range 0-31) with median symptom duration of 7 days (range 1-95). At least one classic symptom or sign was present in 87% of infants but only 14% had the classic triad (projectile vomiting, palpable olive and visible peristalsis). Elevated bicarbonate was present in 61% of blood samples, whereas hypochloraemia was found in only 29%. Ultrasound confirmed the diagnosis in 89%. Surgical techniques were similar in outcome, except that incomplete pyloromyotomy was more common with the laparoscopic compared with periumbilical approach (6% vs 1%, P= 0.023). IHPS occurs more frequently in male and ex-premature infants. It commonly presents without the full spectrum of 'classic' symptoms and signs. Given the availability of ultrasound diagnosis, IHPS should be considered in all babies with any one of the classic findings.

The impact of viral respiratory infection on the severity and recovery from an asthma exacerbation.

BACKGROUND: : Viral respiratory illness triggers asthma exacerbations, but the influence of respiratory illness on the acute severity and recovery of childhood asthma is unknown. Our objective was to evaluate the impact of a concurrent acute respiratory illness (based on a clinical definition and PCR detection of a panel of respiratory viruses, Mycoplasma pneumoniae and Chlamydia pneumoniae) on the severity and resolution of symptoms in children with a nonhospitalized exacerbation of asthma. METHODS: : Subjects were children aged 2 to 15 years presenting to an emergency department for an acute asthma exacerbation and not hospitalized. Acute respiratory illness (ARI) was clinically defined. Nasopharyngeal aspirates (NPA) were examined for respiratory viruses, Chlamydia and Mycoplasma using PCR. The primary outcome was quality of life (QOL) on presentation, day 7 and day 14. Secondary outcomes were acute asthma severity score, asthma diary, and cough diary scores on days 5, 7, 10, and 14. RESULTS: : On multivariate regression, presence of ARI was statistically but not clinically significantly associated with QOL score on presentation (B = -0.36, P = 0.025). By day 7 and 14, there was no difference between groups. Asthma diary score was significantly higher in children with ARI (B = 0.41, P = 0.039) on day 5 but not on presentation or subsequent days. Respiratory viruses were detected in 54% of the 78 NPAs obtained. There was no difference in the any of the asthma outcomes of children grouped by positive or negative NPA. CONCLUSIONS: : The presence of a viral respiratory illness has a modest influence on asthma severity, and does not influence recovery from a nonhospitalized asthma exacerbation.

Asthma and protracted bronchitis: who fares better during an acute respiratory infection?

AIM: Acute respiratory infections (ARI) are common in children, and symptoms range from days to weeks. The aim of this study was to determine if children with asthma have more severe ARI episodes compared with children with protracted bronchitis and controls. METHODS: Parents prospectively scored their child's next ARI using the Canadian acute respiratory illness and flu scale (CARIFS) and a validated cough diary (on days 1-7, 10 and 14 of illness). Children were age- and season-matched. RESULTS: On days 10 and 14 of illness, children with protracted bronchitis had significantly higher median CARIFS when compared with children with asthma and healthy controls. On day 14, the median CARIFS were: asthma = 4.1 (interquartile range (IQR) 4.0), protracted bronchitis = 19.6 (IQR 25.8) and controls = 4.1 (IQR 5.25). The median cough score was significantly different between groups on days 1, 7, 10 and 14 (P < 0.001). A significantly higher proportion of children with protracted bronchitis (63%) were still coughing at day 14 in comparison with children with asthma (24%) and healthy controls (26%). CONCLUSION: Children with protracted bronchitis had the most severe ARI symptoms and higher percentage of respiratory morbidity at day 14 in comparison with children with asthma and healthy controls.

A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial.

OBJECTIVE: To determine whether a 5-day course of oral prednisolone is superior to a 3-day course in reducing the 2-week morbidity of children with asthma exacerbations who are not hospitalised. DESIGN, SETTING AND PARTICIPANTS: Double-blind randomised controlled trial of asthma outcomes following a 5-day course of oral prednisolone (1 mg/kg) compared with a 3-day course of prednisolone plus placebo for 2 days. Participants were children aged 2-15 years who presented to the emergency departments of three Queensland hospitals between March 2004 and February 2007 with an acute exacerbation of asthma, but were not hospitalised. Sample size was defined a priori for a study power of 90%. MAIN OUTCOME MEASURES: Difference in proportion of children who were symptom-free at Day 7, as measured by intention-to-treat (ITT) and per-protocol analysis; quality of life (QOL) on Days 7 and 14. RESULTS: 201 children were enrolled, and there was an 82% completion rate. There was no difference between groups in the proportion of children who were symptom-free (observed difference, 0.04 [95% CI, - 0.09 to 0.18] by ITT analysis; 0.04 [95% CI, - 0.17 to 0.09] by per-protocol analysis). There was also no difference between groups in QOL (P = 0.42). The difference between groups for the primary outcome was within the equivalence range calculated post priori. CONCLUSION: A 5-day course of oral prednisolone confers no advantage over a 3-day course for children with asthma exacerbations who are not hospitalised. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012605000305628.

Best Guess method for age-based weight estimation in paediatric emergencies: validation and comparison with current methods.

BACKGROUND: During paediatric resuscitation, drug doses are calculated based upon weight. Age-based weight estimates are used when weighing children is impractical. The average weight of Australian children has increased, and widely used paediatric age-based formulae might underestimate weight. A modified age-based method for paediatric weight calculation, the 'Best Guess', has been described. OBJECTIVE: To validate the Best Guess formulae on a new population of paediatric emergency patients, and to compare the accuracy of this method with Advanced Paediatric Life Support (APLS) and Australian Resuscitation Council (ARC) formulae for age-based weight calculations. METHODS: A retrospective study was performed of Australasian Triage Scale (ATS) category 1 or 2 patients presenting to a tertiary paediatric ED over a 12 month period. Calculated weights using each method (APLS, ARC and Best Guess) were compared with true weights for infants (<1 year), preschool-aged (1-4 years) and school-aged (5-14 years) children. Mean actual error and mean percentage error for each was calculated. RESULTS: A total of 1843 patient weights were included in the study. The Best Guess Infant formula accurately estimated weight (mean percentage error +4.2%). The Best Guess formulae more accurately estimated weight than both APLS and ARC formulae for both preschool-aged children (mean percentage error +2.6% vs-12.1% vs-12.1%) and school-aged children (mean percentage error +7.7% vs-19.9% vs-12.4%). CONCLUSION: The Best Guess formulae is a valid method for age-based weight estimation in acutely unwell or injured children presenting to the ED and more accurately predicts mean weight than either APLS or ARC formulae.

Prediction tool for bacteraemia in children aged 3-36 months.

PURPOSE: The present study aimed to determine which parameter is the most reliable predictor of bacteraemia in children aged 3-36 months and to develop a simple tool to assess risk of bacteraemia. METHOD: A retrospective review was performed on patients aged 3-36 months who presented to a paediatric ED between July 1999 and April 2004. Children with a febrile illness who had a blood culture and full blood count performed were included in the study. Data were collected from the pathology database (AUSLAB) and Emergency Department Information System (EDIS). Variables examined were age, sex, temperature at presentation, white cell count, neutrophil count and blood culture result. Multiple regression analysis was used to determine the independent predictors of bacteraemia. Non-linear regression analysis was applied to explore alternative patterns of bacteraemia risk. RESULTS: Of the 1488 patients in the dataset, 43 were bacteraemic (2.9%). The most common organism was pneumococcus (74.4%). Sex was evenly distributed (male 52.4%, female 47.6%). Mean temperature at presentation was 38.8 degrees C (95% confidence interval 35.5-41.4 degrees C). The optimal logistic regression model identified neutrophil count as the variable most predictive of bacteraemia, with the odds of bacteraemia increasing by 1.11 for each one-unit increase in neutrophil count. CONCLUSIONS: Neutrophil count is the strongest predictor of bacteraemia in febrile children aged 3-36 months. Based on this, a simple prediction tool can be used to risk stratify this population, and assist in clinical decision making.

Paediatric intussusception: epidemiology and outcome.

OBJECTIVES: (i) To describe the clinical presentation of intussusception and determine features associated with earlier diagnosis; (ii) to describe outcomes of children diagnosed with intussusception; and (iii) to determine whether time to diagnosis is associated with poorer prognosis. METHODS: A retrospective review was performed of all patients presenting to a tertiary paediatric hospital with a diagnosis of intussusception during a 10 year study period. RESULTS: One hundred and forty-one confirmed cases met the inclusion criteria, giving an incidence of one case per 1450 ED presentations. The median age of presentation was 9 months, with a ratio of male to female of 2:1. Three or more of the four 'classic' features of intussusception (vomiting, abdominal pain, bloody/red currant jelly stool, or abdominal mass) were reported in only 46% of presentations. Median time to confirmation of diagnosis was 19 h from onset of symptoms. Ultrasound was the most commonly employed method used to confirm the diagnosis. Air enema had a success rate of 80%, with a reduced success rate beyond the first attempt. Early diagnosis was associated with decreased frequency of surgical intervention and need for bowel resection. CONCLUSION: The 'classic' picture of intussusception might frequently not be present in children with intussusception. Reliance on 'classic' features alone might delay diagnosis. Delayed diagnosis is associated with poorer patient outcomes. Air enema has a high success rate for reduction of intussusception.