Predictors of Intussusception in Young Children

Abstract

Objective: To identify predictors of intussusception in young children.Design: A retrospective cross-sectional study. Setting and Patients:A consecutive sample of children younger than 5 years on whom contrast enemas were performed because of suspected intussusception seen at an urban children's hospital from 1990 to 1995. Methods:We evaluated historical, clinical, and radiographic variables. Variables documented in 75% or more of the medical records and associated with intussusception (PՅ.20) in the univariate analysis were evaluated in a multiple logistic regression analysis. Variables retaining significance (PՅ.05) in the multivariate analysis were considered independent predictors of intussusception. We used bootstrap resampling techniques to validate the multivariate model.Results: Sixty-eight (59%) of the 115 patients had intussusception. Univariate predictors of intussusception included male sex, age younger than 2 years, history of emesis, rectal bleeding, lethargy, abdominal mass, and a highly suggestive abdominal radiograph. In the multivariate analysis, we identified only 4 independent predictors (adjusted odds ratio; 95% confidence interval): a highly suggestive abdominal radiograph (18.3; 4.0-83.1), rectal bleeding (17.3; 2.9-104.0), male sex (6.2; 1.2-32.3), and a history of emesis (13.4; 1.4-126.0). We identified 3 of these 4 variables (all but emesis) as independent predictors in more than 50% of 1000 bootstrap data samples.Conclusions: Rectal bleeding, a highly suggestive abdominal radiograph, and male sex are variables independently associated with intussusception in a cohort of children suspected of having this diagnosis. Knowledge of these variables may assist in clinical decision making regarding diagnostic and therapeutic interventions.Arch Pediatr Adolesc Med. 2000;154:250-255

Intussusception: An anatomical perspective with review of the literature

“…The classic tetrad of symptoms described in children is vomiting, abdominal pain, abdominal mass, and bloody stool (Cooke and Lewis, 1960). However, these symptoms occur simultaneously in less than half of all patients with an intussusception (Kuppermann et al, 2000). A triad of symptoms/ signs for children includes abdominal pain, red currant jelly stool, and palpable abdominal mass (Bowerman et al, 1982).…”

“…Over a short period of time, intussusception can lead to venous compression and edema. Later complications include arterial obstruction, necrosis, perforation, and death (West et al, 1987;Kuppermann et al, 2000;Daneman and Navarro, 2003;Hay et al, 2003;Robb and Lander, 2008).…”

Essential Diagnosis of Abdominal Emergencies in the First Year of Life

“…Intussusception is the most common etiology for bowel obstruction in children younger than 2 years of age [133]. It is estimated to occur in about 1 in 2000 infants and children [133].…”

“…It is estimated to occur in about 1 in 2000 infants and children [133]. The typical age distribution is between 3 months to 6 years of age, and the peak incidence is 5 months to 12 months of age [22,134].…”

“…The negative predictive values were 76%, 49% and 79%, respectively. They argue that the presence of these variables should prompt the clinician to order an air contrast enema [133].…”