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Risk factors and predictive models for early recurrent intussusception in children: a retrospective cohort study
Min Yang1, Yao Xie2, Yangmu Zhuang1
1Department of Pediatric Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Insights
Children older than one year with elevated monocyte ratios, but without vomiting or bloody stools, face a higher risk of early recurrent intussusception. This study identifies key risk factors and develops a predictive model for ERI in children.
Area of Science:
- Pediatric Gastroenterology
- Clinical Risk Prediction
- Biostatistics
Background:
- Early recurrent intussusception (ERI) significantly impacts children's health.
- Limited research exists on identifying risk factors for ERI in pediatric populations.
- This study addresses the need for better understanding and prediction of ERI.
Purpose of the Study:
- To identify independent risk factors associated with ERI in children.
- To develop and validate a predictive model for ERI.
- To provide a clinical tool for assessing ERI risk.
Main Methods:
- Retrospective study involving 787 children with no relapse intussusception (NRI) and 82 with ERI.
- Univariate and multifactorial stepwise logistic regression analysis to identify risk factors.
- Development and validation of a predictive model using logistic regression, ROC curve, and DCA.
Main Results:
- Age, vomiting, bloody stools, and monocyte ratio were identified as independent risk factors for ERI (P<0.05).
- The predictive model demonstrated strong performance with an AUC of 0.883 (95% CI: 0.846-0.920).
- Calibration curves showed good agreement with ideal predictions, and DCA confirmed significant clinical utility.
Conclusions:
- Key independent risk factors for ERI include age, vomiting, bloody stool, and monocyte ratio.
- Children over one year old, without vomiting/bloody stools but with elevated monocytes, are at higher risk.
- The developed predictive model offers a valuable reference for clinicians in managing ERI.
Background:
Early recurrent intussusception (ERI) in children is common and seriously affects the physical and mental health of the children. There are few reports discussing risk factors for ERI in children, and this study aims to identify risk factors for ERI in children and build predictive models.
Methods:
We conducted a retrospective study of 787 children with no relapse intussusception (NRI) and 82 children with ERI between January 2011 and December 2021. Univariate and multifactorial stepwise logistic regression analysis was used to analyze the correlation between 11 factors and ERI, to determine the independent risk factors for ERI in children. The prediction model was established by independent risk factors and then verified.
Results:
Age, vomiting, bloody stools, and monocyte ratios were independently correlated with the composite endpoint (P<0.05). A nomogram was constructed and a calibration curve was plotted, using independent risk factors. Based on the disease's diagnostic score, the predictive model's performance was validated by using logistic regression receiver operating characteristic (ROC) curve detection, with area under the curve (AUC) value of 0.883 [95% confidence interval (CI): 0.846-0.920], and the calibration curve was close to the ideal diagonal line. In addition, the decision curve analysis (DCA) showed that the model had significant net benefits.
Conclusions:
Independent risk factors for ERI in children are age, vomiting, bloody stool, and monocyte ratio. Children older than 1 year in age, who lacked vomiting and bloody stool symptoms, and who exhibited an elevated ratio of monocytes were more likely to relapse early. The predictive model constructed herein can predict the early recurrence of children with ERI, providing a reference for clinicians' individualized judgments.
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