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Risk stratification of children being evaluated for intussusception
Sarah N Weihmiller1, Carlo Buonomo, Richard Bachur
1Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. sweihmiller@gmail.com
Pediatrics
|January 19, 2011
Summary
This study identifies key clinical factors to predict intussusception in children. A new decision tree accurately identifies low-risk patients, aiding in timely diagnosis and preventing complications.
Area of Science:
- Pediatric Gastroenterology
- Medical Diagnostics
Background:
- Intussusception is a leading cause of intestinal obstruction in young children.
- Delayed diagnosis can lead to severe complications like bowel perforation.
Purpose of the Study:
- To identify predictive clinical criteria for intussusception in children.
- To develop a decision tree for risk-stratifying pediatric patients with suspected intussusception.
Main Methods:
- Prospective observational cohort study of children aged 1 month to 6 years.
- Data collection occurred before advanced imaging results were known.
- Recursive partitioning was used to develop decision trees for risk stratification.
Main Results:
- 310 children were enrolled; 12.3% had intussusception.
- Predictors included age >6 months, male gender, lethargy, and abnormal X-ray.
- A decision tree using X-ray, age, diarrhea, and bilious emesis showed high performance (97% sensitivity, 99% NPV).
Conclusions:
- Clinical criteria and a decision tree were prospectively developed.
- This tool aids in risk-stratifying children evaluated for intussusception.
- Accurate risk stratification can improve diagnostic timeliness and patient outcomes.
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