Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction

Abstract

PurposeThe aim of this study was to develop and validate a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction.MethodsChildren with intussusception who had treated with sonographically guided saline hydrostatic reduction as an initial treatment were enrolled in this study. The enrolled patients were randomly selected for training and validation sets, and the split ratio was 7:3. The medical records of enrolled patients were retrospectively reviewed. The patients were divided into a surgery and a non-surgery group according to the results of the nonsurgical reduction. A model for predicting the risk of surgical treatment was virtualized by the nomogram using logistic regression analysis.ResultsThe training set consisted of 139 patients and the validation set included 74. After logistic regression analysis using training set, duration of symptoms, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, poor prognostic signs by ultrasound and mental state were identified as the independent predictors of surgical intervention for intussusception. A model that incorporated the above independent predictors was developed and presented as a nomogram. The C-index of the nomogram in the validation set was 0.948 (95% CI, 0.888–1.000). The calibration curve demonstrated a good agreement between prediction and observation. The decision curve analysis (DCA) curve showed that the model achieved a net benefit across all threshold probabilities.ConclusionBased on the predictors of duration of symptoms, bloody stools, WBCs, CK-MB, long-axis diameter, poor prognostic signs by ultrasound and mental state, we developed a nomogram for predicting surgical intervention after hydrostatic reduction. This nomogram could be applied directly to facilitate pre-surgery decision for pediatric intussusception.

Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China

“…In contrast, the leukocyte count may not be considered as an independent risk factor. This finding contradicts the results of Zhuang et al’s study, 19 in which white blood cell count was found to be an independent risk factor but C-reactive protein was not. Chen et al’s 30 study also confirmed that in cases of intussusception in children, the C-reactive protein levels were significantly higher in patients who underwent enterectomy compared to those who did not.…”

“…They identified timing of onset, mass length, and history of infection as independent predictors. Similarly, Zhuang et al 19 retrospectively analyzed clinical data from 139 children who underwent hydrostatic reduction for intussusception and developed a preoperative nomogram using multiple logistic regression analysis. Their study identified several effective predictors including duration of symptoms, presence of blood in stool, white blood cells count, CK-MB levels, long axis diameter, ultrasound findings indicating adverse prognosis, and mental state of the children.…”

“…Furthermore, our study confirms that the presence of blood in the stool is also a risk factor, consistent with previous research. 19 …”

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

“…The study results were consistent with the findings of previous studies, indicating that a longer duration of illness was more common in patients with intestinal necrosis ( 7 , 11 , 12 , 14 , 19 – 21 ). Longer duration of symptoms before presentation is related to an increase in the loss of intestinal viability ( 18 ).…”

“…Compared with screening for predicting risk factors for intestinal necrosis in pediatric intussusception as shown in previous studies (5,6,11,12), a nomogram integrates more variables and replaces complex statistical models with a simple and straightforward graph (13). Furthermore, in recent years, some researchers have expressed grave concern about the predictive ability of nomograms for intussusception and have stated their potential predictive utility (14,15). To our knowledge, there are few studies focusing on Abdominal pain, vomiting, and bloody stool constitute the classic triad of intussusception, but are presented in less than 33% of children upon admission (16).…”