Risk factors for pediatric intussusception complicated by loss of intestine viability in China from June 2009 to May 2014: a retrospective study

Yao, Xianming; Chen, Zhongliang; Shen, Delei; Zhou, Qishuang; Huang, Su; Cai, Zuren; Tong, Yulong; Wang, Meng; Ren, Yi; Lai, Xin‐He; Chen, Xiaoming

doi:10.1007/s00383-014-3653-0

Cited by 18 publications

(11 citation statements)

References 21 publications

(22 reference statements)

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“…In our study, none of the 11 patients who underwent surgical reduction required resection due to bowel ischemia. Xian-Ming et al concluded that the median time between symptom onset and operative treatment for intussusception was longer in patients who lost intestinal viability (42 h) than for those who did not (19 h) [17]. In our study, the median time between symptom onset and the procedure was 9 h, which was shorter than that reported by Xian-Ming et al, suggesting that intestinal viability had been preserved.…”

Section: Discussioncontrasting

confidence: 59%

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

et al. 2020

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Background: Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Methods: The electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure. Results: A total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively. Conclusion: Lactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.

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Section: Discussioncontrasting

confidence: 59%

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

et al. 2020

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“…In that study, the median duration of symptoms in the overall patients, group with an unviable intestine, and group with a viable intestine was 23, 42, and 19 hours, respectively, and this result was significantly different. 14 Long duration of symptoms before presentation related to increase in the loss of intestinal viability. So, the duration of symptoms was not a contraindication for the nonoperative reduction, and some cases with a long symptom duration (minimum =1 hour and maximum =120 hours in success group) in our study had successful reduction.…”

Section: Discussionmentioning

confidence: 99%

Prognostic indicators for failed nonsurgical reduction of intussusception

Khorana¹,

Singhavejsakul²,

Ukarapol

et al. 2016

TCRM

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PurposeTo identify the risk factors for failure of nonsurgical reduction of intussusception.MethodsData from intussusception patients who were treated with nonsurgical reduction in Chiang Mai University Hospital and Siriraj Hospital between January 2006 and December 2012 were collected. Patients aged 0–15 years and without contraindications (peritonitis, abdominal X-ray signs of perforation, and/or hemodynamic instability) were included for nonsurgical reduction. The success and failure groups were divided according to the results of the reduction. Prognostic indicators for failed reduction were identified by using generalized linear model for exponential risk regression. The risk ratio (RR) was used to report each factor.ResultsOne hundred and ninety cases of intussusception were enrolled. Twenty cases were excluded due to contraindications. A total of 170 cases of intussusception were included for the final analysis. The significant risk factors for reduction failure clustered by an age of 3 years were weight <12 kg (RR =1.48, P=0.004), symptom duration >3 days (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 abdominal mass (RR =1.26, P<0.001), location of mass (left over right side) (RR =1.48, P<0.001), poor prognostic signs on ultrasound scans (RR =1.35, P<0.001), and method of reduction (hydrostatic over pneumatic) (RR =1.34, P=0.023). The prediction ability of this model was 82.21% as assessed from the area under the receiver operating characteristic curve.ConclusionThe identified prognostic factors for the nonsurgical reduction failure may help to predict the reduction outcome and provide information to the parents.

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“…Intussusception is one of the most common causes of an acute abdomen in the pediatric emergency clinic and is the leading cause of acute bowel obstruction in infants and young children (1)(2)(3). In general, most intussusceptions can be categorized as primary or idiopathic, with thickened bowel wall lymphoid tissue (Peyer patches) acting as the lead point.…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Nomogram for Predicting Pathological Intussusceptions in Children Prior to Surgical Intervention

Duan

Liu

et al. 2022

Front. Pediatr.

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PurposeEstablish and validate a nomogram to help predict the preoperative risk of a pathological intussusception.MethodsA primary cohort of patients who underwent surgery for an intussusception were enrolled from one center, while a validation cohort consisted of patients from another center. Multivariate logistic regression analysis was used to identify the variables to build the nomogram. A calibration curve accompanied by the Hosmer-Lemeshow test was used to assess the calibration of the nomogram. To quantify the discrimination of the nomogram, Harrell’s C-index was calculated. The performance of the validated nomogram was tested in the external validation cohort. The logistic regression formulae created during the analysis of the primary cohort was applied to all patients in the external validation cohort, and the total points for each patient were calculated.ResultsThe primary cohort consisted of 368 patients and the validation cohort included 74. The LASSO logistic algorithm identified three (recurrence episodes, mass size, and infection history) out of 11 potential clinical variables as significantly predictive of a pathologic intussusception. The C-index for the predictive nomogram was 0.922 (95% CI, 0.885–0.959) for the primary cohort and 0.886 (95% CI, 0.809–0.962) for the validation cohort. The decision curve showed that if the threshold probability of a patient in the validation cohort was > 7%, then the nomogram was more beneficial than either indiscriminately treating all or none of the patients.ConclusionWe developed a nomogram based on clinical risk factors that could be used to individually predict pathological intussusceptions in children prior to surgical intervention.

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Risk factors for pediatric intussusception complicated by loss of intestine viability in China from June 2009 to May 2014: a retrospective study

Abstract: The result of our risk factor analysis for loss of intestine viability in pediatric intussusception cases may help develop a predictability index to prevent the complication to happen. Further prospective studies are required to confirm our findings.

Cited by 18 publications

References 21 publications

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

Lactic acid level as an outcome predictor in pediatric patients with intussusception in the emergency department

Prognostic indicators for failed nonsurgical reduction of intussusception

Development and Validation of a Nomogram for Predicting Pathological Intussusceptions in Children Prior to Surgical Intervention

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