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Risk factors and A nomogram predictive model for failure of ultrasound guided hydrostatic enema reduction in
Hongjia Qiang1, Xin Li1, Zhaozheng Ding1
1Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China.
Insights
Young children (<1 year) with intussusception are at higher risk for failed hydrostatic enema reduction. Vomiting, symptom duration, and specific ultrasound findings predict failure, aiding treatment decisions.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Surgical Risk Stratification
Background:
- Intussusception is a common pediatric surgical emergency.
- Hydrostatic enema reduction is a primary treatment modality.
- Predicting reduction failure is crucial for timely intervention.
Purpose of the Study:
- Identify independent risk factors for hydrostatic enema reduction failure in pediatric intussusception.
- Develop and validate a predictive nomogram for early identification of at-risk patients.
Main Methods:
- Retrospective cohort study of 481 pediatric patients with intussusception.
- Ultrasound-guided hydrostatic enema reduction.
- Multivariable logistic regression and nomogram construction with internal and external validation.
Main Results:
- Seven independent predictors of failure identified: age <1 year, vomiting, prolonged symptoms, large mass, transverse colon location, abnormal Doppler signals, and bowel wall thickness >3mm.
- Nomogram showed high predictive accuracy (AUC 0.901-0.929).
- Excellent calibration and clinical utility demonstrated.
Conclusions:
- Key clinical and sonographic factors predict hydrostatic enema reduction failure in pediatric intussusception.
- The validated nomogram aids in risk stratification and optimizing treatment strategies.
- Facilitates timely surgical consultation for high-risk cases.
Objective:
To identify independent risk factors for failure of hydrostatic enema reduction in children with primary intussusception and to develop and validate a nomogram for early prediction.
Methods:
A retrospective cohort study was conducted on 481 pediatric in-patients with confirmed intussusception who underwent ultrasound-guided hydrostatic enema reduction at Lianyungang First People's Hospital between January 2021 and December 2024. Patients were divided into a successful-reduction group (n = 434) and a failed-reduction group (n = 47). Demographic data, clinical manifestations, and ultrasonographic findings were extracted. Univariate analyses (independent-samples t-test, χ2 test, and Mann-Whitney U test) were performed to compare the two groups. Variables with P < 0.05 were entered into a multivariable binary logistic regression model to determine independent predictors of failure. A nomogram was constructed based on the regression coefficients, and its discriminative performance was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping; an external validation cohort (n = 73) enrolled between January 2025 and August 2025 was used to confirm generalizability.
Results:
Multivariable analysis revealed seven independent predictors of enema-reduction failure: age < 1 year, vomiting, longer duration of symptoms, larger "target" mass diameter, intussusception located in the transverse colon, abnormal color Doppler flow signals within the bowel wall, and bowel-wall thickness > 3 mm. The nomogram achieved an AUC of 0.901 (95 % CI: 0.862-0.941) in the derivation cohort and 0.929 (95 % CI: 0.866-0.991) in the external validation cohort. Calibration curves demonstrated excellent agreement between predicted and observed probabilities; decision-curve analysis indicated substantial clinical net benefit.
Conclusions:
Age < 1 year, vomiting, prolonged symptom duration, large target mass, transverse-colon location, compromised mural perfusion, and marked bowel-wall edema are significant risk factors for failure of hydrostatic enema reduction in pediatric intussusception. The proposed nomogram exhibits robust predictive performance and may facilitate risk stratification, timely surgical consultation, and optimization of treatment strategies.
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