Nomogram for the Estimation of Intestinal Necrosis Risk in Incarcerated Inguinal Hernia in Infants under 6 Months

This article develops a nomogram to estimate intestinal necrosis risk in the incarcerated inguinal hernia (IIH) in infants under 6 months.

A total of 273 infants who underwent an emergency operation due to IIH were investigated retrospectively. Univariate and multivariate logistic regression were used to analyze the relationship between variables and intestinal necrosis and construct a nomogram of intestinal necrosis. The discrimination and concordance of the model were verified by receiver operating characteristic (ROC) analysis and calibration curve, and the bootstrap method was used for internal validation of the model. The clinical applicability of the model was evaluated using the decision curve and the clinical impact curve.

Intestinal necrosis was found in 37 of 273 infants (13.6%) in this study. The vomiting symptoms, platelet count, C-reactive protein, and neutrophil-lymphocyte ratio were independent risk factors for intestinal necrosis in IIH. We then constructed a nomogram with these four factors. ROC analysis showed that the nomogram had a good diagnostic performance, with the area under the curve (AUC), sensitivity, and specificity of 0.918 (95% confidence interval: 0.880-0.956), 97.3%, and 69.9%, respectively. The nomogram was further validated using 2,000-repetition internal bootstrap validation, and the values of AUC, sensitivity, and specificity were 0.899, 95.7%, and 50.5%, respectively. The decision curve and the clinical impact curve indicated that the predictive model has a favorable clinical application.

The nomogram can be used to predict intestinal necrosis in IIH, and allow us to estimate the severity of IIH more accurately and arrange the treatment process more reasonably.