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Development of a predictive model for surgical intervention following air enema reduction of pediatric
Min Yang1,2, Xianfeng Rao3, Anqi Huang4
1Department of Pediatric Surgery, The Sixth Affiliated Hospital of Harbin Medical University, Harbin, China.
Insights
A new predictive model helps determine if children need surgery after air enema for intussusception. This tool aids early decisions, reducing risks like intestinal perforation and necrosis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Informatics
Background:
- Surgical intervention is common after failed air enema for pediatric intussusception.
- Prompt treatment is crucial to prevent severe complications like intestinal perforation and necrosis.
- Developing a predictive model can optimize post-enema treatment decisions.
Purpose of the Study:
- To develop and validate a prediction model for surgical intervention following air enema in pediatric intussusception.
- To identify key risk factors associated with the need for surgery.
- To reduce the incidence of serious complications by enabling timely treatment decisions.
Main Methods:
- Retrospective study of 963 children (2011-2021): 843 successful air enema reductions, 120 surgical interventions.
- Logistic regression analysis to identify independent risk factors for surgical intervention.
- Model development using a training set (70%) and validation using a validation set (30%), assessed with ROC curves, calibration curves, and DCA.
Main Results:
- Six factors independently associated with surgical intervention: age, symptom duration, bloody stools, body temperature, lymphocyte percentage, and basophil percentage (p < 0.05).
- The developed nomogram, based on these six factors, achieved an Area Under the ROC Curve of 0.879.
- Calibration curves demonstrated good agreement with ideal predictions, and Decision Curve Analysis indicated significant clinical utility.
Conclusions:
- A reliable predictive model for surgical intervention after air enema in pediatric intussusception has been developed.
- The model utilizes objectively measurable indicators, aiding clinicians in early decision-making for post-enema management.
- This tool supports informed choices between continued enema therapy or proceeding to surgery, aiming to minimize complications.
Background:
Surgical intervention after air enema for paediatric intussusception is very common, and prompt surgical treatment after failure of air enema therapy is the key to reducing serious complications, such as intestinal perforation and intestinal necrosis caused by intussusception. The aim of this study was to develop and validate a prediction model for surgical intervention after air enema in paediatric intussusception to reduce the incidence of serious complications.
Methods:
A retrospective study was performed on 843 children who were successfully reduced by air enema and 120 children who underwent surgical intervention after air enema in our hospital from January 2011 to December 2021. Baseline information, clinical presentation and test results of the children on admission were recorded. Univariate and multivariate logistic regression analyses were used to identify independent risk factors for surgical intervention after air enema for paediatric intussusception. Meanwhile, we developed a predictive model to predict surgical intervention after air enema for paediatric intussusception based on independent risk factors and validated the model using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).
Results:
Age, duration of symptoms, bloody stools, body temperature, lymphocyte percentage and basophil percentage were independently associated with the composite endpoint (p < 0.05). The patients were randomly divided into a training set and a validation set at a ratio of 7:3 for model construction and validation, respectively. A logistic regression model was constructed based on the above six factors and integrated into the nomogram. The area under the ROC curve of the nomogram constructed by 6 independent risk factors reached 0.879, and the calibration curve was close to the ideal diagonal. In addition, DCA analysis revealed significant net benefits of the model.
Conclusions:
Our predictive model for surgical intervention after air enema in pediatric intussusception, developed using objectively measurable indicators, demonstrates reliable predictive capability. It provides clinicians with an effective and dependable tool for early decision-making regarding post-enema treatment strategies-whether to continue with enema or proceed to surgery.
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