Prognostic indicators for failed nonsurgical reduction of intussusception

Khorana, Jiraporn; Singhavejsakul, Jesda; Ukarapol, Nuthapong; Laohapensang, Mongkol; Siriwongmongkol, Jakraphan; Patumanond, Jayanton

doi:10.2147/tcrm.s109785

Cited by 35 publications

(51 citation statements)

References 21 publications

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“…Literature shows that rectal bleeding decreases the success rate of reduction (18,19,(23)(24)(25)(26)(27)(28)(29). Rectal bleeding is an indicator of edema and circulatory impairment and is seen in 60% of the patients with intussusceptions (3).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

2018

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Background: Intussusception is a major cause of acute abdomen in childhood. Prompt diagnosis and appropriate treatment of intussusception is of prime importance for preventing morbidity and mortality. In this study, we aimed to investigate the effectivity of ultrasound (USG)-guided hydrostatic reduction of intussusception with saline and to investigate the factors affecting the success of this method. Methods: A total of 100 children with intussusception who were treated by hydrostatic reduction with saline were retrospectively reviewed. The effect of age, gender, duration of symptoms, rectal bleeding, number of reduction attempts performed, and the diameter and length of the invaginated segment measured on USG were evaluated. Results: Successful reduction was achieved in 88 (88%) patients. Mean age was 24.83 months, with 25.59 months in patients with successful reduction and 20 months in patients with failed reduction. Reduction was successful in 83.9% of the patients with a history of rectal bleeding and in 94.7% of the patients with no history of rectal bleeding (P > 0.05). Mean duration of symptoms was 2.74 days in the patients with successful reduction and 4.33 days in the patients with failed reduction. The mean diameter and length of the invaginated segments measured on USG were 3.5 cm and 5.12 cm in the patients with successful reduction and 4.27 cm and 9.23 cm in the patients with failed reduction, respectively. No significant difference was observed between the patients with successful and failed reduction in terms of rectal bleeding, vomiting, gender, age, and body weight (P > 0.05). It was also found that success rate increased as the number of reduction attempts increased and the success rate decreased as the duration of symptoms and the diameter and the length of the invaginated segment increased (P < 0.05). Conclusions:In conclusion, USG-guided reduction of intussusception with saline is a practical and safe method that yields high success rates. Repeating this method in patients with partial reduction that are clinically stable leads to a significant increase in the success of the procedure. A prolonged duration of symptoms and an increase in the size and the diameter of the invaginated segment may have adverse effects on the success of the procedure.

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Section: Discussionmentioning

confidence: 99%

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

2018

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“…The CMUI scoring system was created by Khorana et al from CMU, Thailand,10 with an aim to be used as a predictor of failure in non-surgical treatment of intussusception. The scoring system consists of 10 items, that is, body weight less than 12 kg, duration of symptoms more than 48 hours, vomiting, rectal bleeding, abdominal distension, temperature more than 37.8°C, palpable mass, location, poor ultrasound signs, and method of reduction.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, bypassing any attempt at non-surgical management in cases with a poor probability of successful reduction could also avoid complications caused by prolonged strangulation 9. Various clinical and radiologic factors have been reported as being associated with failure of non-surgical management for intussusception, which can be subcategorized into four groups: demographic factors, clinical symptoms, physical examination factors and imaging factors 6 10. Regarding demographic factors and clinical symptoms, younger age, longer duration of abdominal pain, rectal bleeding, presence of diarrhea, abdominal distension, and dehydration or vomiting are the main unfavorable factors.…”

Section: Introductionmentioning

confidence: 99%

Validation and modification of the ‘Chiang Mai University Intussusception scoring system’ used to predict failure of non-surgical treatment in infantile intussusception

Boonsanit

Kritsaneepaiboon

Chiengkriwate

et al. 2019

World Jnl Ped Surgery

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BackgroundThis study aimed to validate and modify the recently released Chiang Mai University Intussusception (CMUI) scoring system in predicting failure of non-surgical management of infantile intussusception.MethodsA retrospective review was conducted in 151 cases of infantile intussusception who were primarily treated with pneumatic reduction in our institute during 2008–2018. The analysis focused on the validation of the CMUI scoring system. Following this analysis, the scoring system was modified to be more suitable for our clinical practice, in which we perform pneumatic reduction in all cases.ResultsPneumatic reduction was successfully performed in 120/151 cases (79.5%). A high CMUI score was significantly associated with increased likelihood of failure at the positive likelihood ratio of 1.49 (sensitivity 25.8 and specificity 82.7). The area under the receiver operating characteristic curve (AUC) was 0.73. We modified the CMUI System in two ways, first by removing the item ‘method of reduction’ and replacing it with ‘hyponatremia’, and by changing the definition of low body weight to less than 9 kg. The modified CMUI had an AUC of 0.76. A high score (>9 points) on the modified version gave a positive likelihood ratio of 4.77 (sensitivity 53.0 and specificity 80.9).ConclusionIn infantile intussusception primarily treated with pneumatic reduction, the modified CMUI scoring system gave a better prediction reliability than the original.

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“… 9 The second study reported the prognostic indicators of failed operative reduction. 8 This was the third study that used ten prognostic factors for failed nonsurgical reduction derived from the second study.…”

Section: Methodsmentioning

confidence: 99%

“…Our earlier series studied the prognosis indicators for failed reduction and found that body weight <12 kg, duration of symptoms >3 days, vomiting, rectal bleeding, abdominal distension, temperature >37.8°C, palpable abdominal mass, location of mass on the left side, ultrasound showing poor prognostic signs, and the method of reduction (hydrostatic over pneumatic) were the factors. 8 …”

Section: Introductionmentioning

confidence: 99%

Clinical prediction rules for failed nonoperative reduction of intussusception

Khorana¹,

Patumanond²,

Ukarapol³

et al. 2016

TCRM

Self Cite

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PurposeThe nonoperative reduction of intussusception in children can be performed safely if there are no contraindications. Many risk factors associated with failed reduction were defined. The aim of this study was to develop a scoring system for predicting the failure of nonoperative reduction using various determinants.Patients and methodsThe data were collected from Chiang Mai University Hospital and Siriraj Hospital from January 2006 to December 2012. Inclusion criteria consisted of patients with intussusception aged 0–15 years with no contraindications for nonoperative reduction. The clinical prediction rules were developed using significant risk factors from the multivariable analysis.ResultsA total of 170 patients with intussusception were included in the study. In the final analysis model, 154 patients were used for identifying the significant risk factors of failure of reduction. Ten factors clustering by the age of 3 years were identified and used for developing the clinical prediction rules, and the factors were as follows: body weight <12 kg (relative risk [RR] =1.48, P=0.004), duration of symptoms >48 hours (RR =1.26, P<0.001), vomiting (RR =1.63, P<0.001), rectal bleeding (RR =1.50, P<0.001), abdominal distension (RR =1.60, P=0.003), temperature >37.8°C (RR =1.51, P<0.001), palpable mass (RR =1.26, P<0.001), location of mass (left over right side RR =1.48, P<0.001), ultrasound showed poor prognostic signs (RR =1.35, P<0.001), and the method of reduction (hydrostatic over pneumatic, RR =1.34, P=0.023). Prediction scores ranged from 0 to 16. A high-risk group (scores 12–16) predicted a greater chance of reduction failure (likelihood ratio of positive [LR+] =18.22, P<0.001). A low-risk group (score 0–11) predicted a lower chance of reduction failure (LR+ =0.79, P<0.001). The performance of the scoring model was 80.68% (area under the receiver operating characteristic curve).ConclusionThis scoring guideline was used to predict the results of nonoperative reduction and forecast the prognosis of the failed reduction. The usefulness of these prediction scores is for informing the parents before the reduction. This scoring system can be used as a guide to promote the possible referral of the cases to tertiary centers with facilities for nonoperative reduction if possible.

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Prognostic indicators for failed nonsurgical reduction of intussusception

Cited by 35 publications

References 21 publications

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

Ultrasound Guided Reduction of Intussusception with Saline and Evaluating the Factors Affecting the Success of the Procedure

Validation and modification of the ‘Chiang Mai University Intussusception scoring system’ used to predict failure of non-surgical treatment in infantile intussusception

Clinical prediction rules for failed nonoperative reduction of intussusception

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