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Paediatric Intussusception: A Clinical Scoring System to Predict the Risk of Operative Intervention
Charu Tiwari1, Hemanshi Shah2, Gursev Sandlas3
1Registrar, Department of Paediatric Surgery, TNMC & BYL Nair Hospital, Mumbai Central, Mumbai, Maharashtra, India. Pin: 400008.
Insights
A new clinical score can predict the need for surgery in children with intussusception. Higher scores indicate a greater likelihood of operative intervention, aiding early surgical decisions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Decision Support
Background:
- Intussusception is a frequent cause of bowel obstruction in children.
- Prompt diagnosis and treatment are crucial to avert severe complications.
- A clinical scoring system is needed to predict operative intervention risk.
Purpose of the Study:
- To develop and validate a clinical scoring system for predicting operative intervention in pediatric intussusception.
- To identify key clinical parameters indicative of surgical necessity.
Main Methods:
- Retrospective analysis of 100 pediatric intussusception cases to derive a clinical score.
- Score based on age, abdominal distention, vomiting, palpable lump, stool characteristics, and pain duration.
- Validation of the score on an additional 50 consecutive patients.
Main Results:
- 13 out of 100 patients required surgery; 87 were managed non-operatively.
- A score of 10 or less was associated with successful non-operative management (ultrasound-guided hydrostatic reduction).
- Predictors for operative intervention included age (<3 months or >2 years), abdominal lump, currant jelly stools, and pain duration (≥2 days).
Conclusions:
- The developed clinical score effectively predicts the risk of operative intervention in pediatric intussusception.
- Abdominal distention, palpable lump, currant jelly stools, and prolonged pain (≥48 hours) are strong indicators for surgery.
- A higher score (≥8) correlates with an increased probability of requiring operative intervention, supporting early surgical decision-making.
Background:
Intussusception is a common cause of obstruction in paediatric patients. Rapid clinical recognition and treatment is important to prevent potentially fatal complications. The present study aims to derive a clinical scoring system for prediction of risk of operative intervention in patients with intussusception.
Materials And Methods:
Data of 100 patients with intussusception were analyzed retrospectively, and a score was calculated based on clinical parameters - age, presence/absence of symptoms and signs such as abdominal distention, vomiting, lump abdomen, red currant jelly stools and duration of abdominal pain. The maximum score was 12, and the minimum score was 6. This score was then applied to other 50 consecutive patients with intussusception.
Results:
Of 100, 13 patients required operative intervention; 87 patients were managed by hydrostatic reduction. In all, four patients with a score of 12 and five patients with a score of 11 required operative intervention. Seven patients had a score of 10, out of which four (57.14%) required operative intervention. A total of 87 patients who had a score of 10 or less were successfully managed non-operatively by ultrasound-guided hydrostatic reduction. In the next 50 patients, two patients with a score of 9 and all patients with scores of 10 and 11 required operative intervention. Thus, age less than 3 months and more than 2 years, presence of symptoms such as abdominal lump, red currant jelly stools and duration of abdominal pain of 2 or more days were strong predictors of operative intervention.
Conclusion:
This clinical score helps to predict the risk of operative intervention required in a child with a diagnosis of intussusceptions - duration of abdominal pain of 48 h or more, presence of abdominal distention and lump and red currant jelly stools are strong predictors of need of operative intervention in patients with intussusception. Higher the score (8 or more, as concluded by this study), more the probability of requiring operative intervention in these patients. Though limited, this study could serve as a pilot work to develop a user-friendly score for early surgical decision making in the management of paediatric intussusception.
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