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Prognostic indicators for failed nonsurgical reduction of intussusception
Jiraporn Khorana1, Jesda Singhavejsakul1, Nuthapong Ukarapol2
1Division of Pediatric Surgery, Department of Surgery.
Insights
Key risk factors for failed nonsurgical reduction of intussusception include young age, prolonged symptoms, and specific clinical signs. Identifying these factors aids in predicting outcomes for children undergoing this procedure.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes Research
Background:
- Intussusception is a common cause of intestinal obstruction in infants and children.
- Nonsurgical reduction is the preferred initial treatment for most intussusception cases.
- Predicting the success of nonsurgical reduction is crucial for patient management.
Purpose of the Study:
- To identify and analyze the risk factors associated with the failure of nonsurgical reduction in pediatric intussusception.
- To develop a predictive model for nonsurgical reduction outcomes.
Main Methods:
- Retrospective analysis of intussusception patients treated with nonsurgical reduction at two university hospitals (2006-2012).
- Inclusion criteria: age 0-15 years, absence of contraindications (peritonitis, perforation signs, hemodynamic instability).
- Statistical analysis using generalized linear models for exponential risk regression to identify prognostic indicators.
Main Results:
- 170 patients were included in the final analysis.
- Significant risk factors for reduction failure included: weight <12 kg, symptom duration >3 days, vomiting, rectal bleeding, abdominal distension, fever (>37.8°C), palpable abdominal mass, mass location (left over right), poor ultrasound signs, and hydrostatic reduction method.
- The predictive model demonstrated 82.21% accuracy (AUC).
Conclusions:
- Several clinical and imaging factors significantly predict nonsurgical reduction failure in intussusception.
- These identified prognostic factors can assist clinicians in predicting reduction outcomes.
- Informing parents about potential risks based on these factors is important for shared decision-making.
Purpose:
To identify the risk factors for failure of nonsurgical reduction of intussusception.
Methods:
Data 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.
Results:
One 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.
Conclusion:
The 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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