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Developing a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction.

Yize Zhuang¹, Xun Wang¹, Xia Fan¹

¹Department of Pediatric Surgery, Guizhou Provincial People's Hospital, Guizhou, China.

Frontiers in Pediatrics

|June 16, 2023

Summary

This study developed a nomogram to predict surgery needs in pediatric intussusception after hydrostatic reduction. The tool accurately identifies children requiring surgical intervention, aiding pre-operative decisions.

Keywords:

hydrostatic reduction intussusception nomogram predictors risk factors

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Area of Science:

Pediatric Surgery
Gastroenterology
Medical Imaging

Background:

Intussusception is a common surgical emergency in children.
Hydrostatic reduction is a primary treatment, but predicting surgical intervention is challenging.

Purpose of the Study:

To develop and validate a nomogram for predicting surgical intervention in pediatric intussusception post-hydrostatic reduction.
To identify key clinical and ultrasound predictors for surgical risk.

Main Methods:

Retrospective review of 213 pediatric intussusception cases treated with sonographically guided saline hydrostatic reduction.
Patients randomly assigned to training (70%) and validation (30%) sets.
Logistic regression analysis to identify predictors and develop a nomogram.

Main Results:

Seven independent predictors identified: symptom duration, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, ultrasound poor prognostic signs, and mental state.
The nomogram achieved a high predictive accuracy with a C-index of 0.948 in the validation set.
Calibration and decision curve analyses confirmed the nomogram's reliability and clinical utility.

Conclusions:

A validated nomogram effectively predicts the need for surgical intervention in pediatric intussusception following hydrostatic reduction.
The nomogram incorporates clinical and imaging findings to guide pre-operative decision-making.
This tool can assist clinicians in managing pediatric intussusception cases more efficiently.