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Published on: December 1, 2012
Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric
Yuan-Yang Yu1, Jia-Jie Zhang1, Ya-Ting Xu1
1Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Insights
A new nomogram helps predict the need for intestinal resection in children with intussusception and suspected necrosis after failed air-enema reduction. This tool aids in surgical decision-making for pediatric intussusception cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Intussusception is a common surgical emergency in children.
- Intestinal necrosis is a severe complication requiring surgical resection.
- Predicting the need for resection after failed reduction is clinically significant.
Purpose of the Study:
- To develop and validate a predictive nomogram for intestinal resection in pediatric intussusception with suspected intestinal necrosis.
- To improve clinical decision-making in cases of failed air-enema reduction.
Main Methods:
- Retrospective enrollment of children with intussusception and failed air-enema reduction.
- Logistic regression analysis to identify predictive factors.
- Development and validation of a nomogram using training and validation sets (3:1 ratio).
- Evaluation of the nomogram using calibration curves and C-index.
Main Results:
- A total of 547 children were analyzed; 133 required intestinal resection.
- Four variables were identified: symptom duration, C-reactive protein, white blood cells, and ascites.
- The developed nomogram achieved a concordance index of 0.871 (95% CI: 0.834-0.908).
Conclusions:
- A validated nomogram effectively predicts intestinal resection in pediatric intussusception with suspected necrosis.
- The nomogram can aid clinicians in managing children with intussusception after failed reduction.
- This tool supports informed surgical decisions, potentially reducing unnecessary resections.
Purpose:
Develop and validate a nomogram for predicting intestinal resection in pediatric intussusception suspecting intestinal necrosis.
Patients & Methods:
Children with intussusception were retrospectively enrolled after a failed air-enema reduction in the outpatient setting and divided into two groups: the intestinal resection group and the non-intestinal resection group. The enrolled cases were randomly selected for training and validation sets with a split ratio of 3:1. A nomogram for predicting the risk of intestinal resection was visualized using logistic regression analysis with calibration curve, C-index, and decision curve analysis to evaluate the model.
Results:
A total of 547 cases were included in the final analysis, of which 414 had non-intestinal necrosis and 133 had intestinal necrosis and underwent intestinal resection. The training set consisted of 411 patients and the validation cohort included 136 patients. Through forward stepwise regression, four variables (duration of symptoms, C-reaction protein, white blood cells, ascites) were selected for inclusion in the nomogram with a concordance index 0.871 (95% confidence interval: 0.834-0.908).
Conclusion:
We developed a nomogram for predicting intestinal resection in children with intussusception suspecting intestinal necrosis after a failed air-enema based on multivariate regression. This nomogram could be directly applied to facilitate predicting intestinal resection in pediatric intussusception suspecting necrosis.
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