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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.
Insights
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.
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.
Purpose:
The aim of this study was to develop and validate a nomogram for predicting surgical intervention in pediatric intussusception after hydrostatic reduction.
Methods:
Children with intussusception who had treated with sonographically guided saline hydrostatic reduction as an initial treatment were enrolled in this study. The enrolled patients were randomly selected for training and validation sets, and the split ratio was 7:3. The medical records of enrolled patients were retrospectively reviewed. The patients were divided into a surgery and a non-surgery group according to the results of the nonsurgical reduction. A model for predicting the risk of surgical treatment was virtualized by the nomogram using logistic regression analysis.
Results:
The training set consisted of 139 patients and the validation set included 74. After logistic regression analysis using training set, duration of symptoms, bloody stools, white blood cells (WBCs), creatine kinase isoenzyme (CK-MB), long-axis diameter, poor prognostic signs by ultrasound and mental state were identified as the independent predictors of surgical intervention for intussusception. A model that incorporated the above independent predictors was developed and presented as a nomogram. The C-index of the nomogram in the validation set was 0.948 (95% CI, 0.888-1.000). The calibration curve demonstrated a good agreement between prediction and observation. The decision curve analysis (DCA) curve showed that the model achieved a net benefit across all threshold probabilities.
Conclusion:
Based on the predictors of duration of symptoms, bloody stools, WBCs, CK-MB, long-axis diameter, poor prognostic signs by ultrasound and mental state, we developed a nomogram for predicting surgical intervention after hydrostatic reduction. This nomogram could be applied directly to facilitate pre-surgery decision for pediatric intussusception.
