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Published on: October 16, 2013
Scoring System to Evaluate Risk of Nonoperative Management Failure in Children With Intussusception
Michela Carter1, Jonathan Afowork1, J Benjamin Pitt1
1Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
Insights
A new scoring system accurately predicts when children with intussusception will need surgery after failed enema reduction. This tool helps identify high-risk cases for better management of intussusception in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Surgical Intervention
- Medical Diagnostics
Background:
- Intussusception management in children typically begins with enema reduction.
- Failure of nonoperative management necessitates surgical intervention.
- Predictors of failed nonoperative management are not consistently applied in clinical practice.
Purpose of the Study:
- To develop a predictive scoring system for nonoperative management failure in pediatric intussusception.
- To identify children at high risk for requiring surgical intervention.
Main Methods:
- Retrospective review of 143 pediatric intussusception cases (2019-2022).
- Logistic regression analysis to identify predictors of nonoperative failure.
- Development of a risk scoring system based on significant predictors.
Main Results:
- 19.6% of cases required operative intervention.
- Key predictors of failure included age ≥4 years, ≥1 failed enema attempts, heart rate ≥128, systolic blood pressure ≥115 mmHg, and trapped fluid on ultrasound.
- The developed scoring system demonstrated high discriminative ability (AUC 0.96) with varying failure risks based on scores (low ≤2, moderate 3-4, high ≥5).
Conclusions:
- A novel risk scoring system effectively predicts surgical intervention needs in pediatric intussusception.
- The system utilizes established risk factors and shows excellent predictive capability.
- Prospective validation is recommended before clinical implementation.
Introduction:
Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention.
Methods:
Children diagnosed with intussusception upon presentation to the emergency department of a tertiary children's hospital between 2019 and 2022 were retrospectively identified. Univariable logistic regression identified predictors of nonoperative failure used as starting covariates for multivariable logistic regression with final model determined by backwards elimination. Regression coefficients for final predictors were used to create the scoring system and optimal cut-points were delineated.
Results:
We identified 143 instances of ultrasound-documented intussusception of which 28 (19.6%) required operative intervention. Predictors of failed nonoperative management included age ≥4 y (odds ratio [OR] 32.83, 95% confidence interval [CI]: 1.91-564.23), ≥1 failed enema reduction attempts (OR 189.53, 95% CI: 19.07-1884.11), presenting heart rate ≥128 (OR 3.38, 95% CI: 0.74-15.36), presenting systolic blood pressure ≥115 mmHg (OR 6.59, 95% CI: 0.93-46.66), and trapped fluid between intussuscepted loops on ultrasound (OR 17.54, 95% CI: 0.77-397.51). Employing these factors, a novel risk scoring system was developed (area under the curve 0.96, 95% CI: 0.93-0.99). Scores range from 0 to 8; ≤2 have low (1.1%), 3-4 moderate (50.0%), and ≥5 high (100%) failure risk.
Conclusions:
Using known risk factors for enema failure, we produced a risk scoring system with outstanding discriminate ability for children with intussusception necessitating surgical intervention. Prospective validation is warranted prior to clinical integration.
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