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Predicting early recurrence after hydrostatic reduction of pediatric intussusception: A nomogram and a simplified
Zhaozheng Ding1, Hongjia Qiang1, Xin Li1
1Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Affiliated to Kangda College of Nanjing Medical University, Lianyungang, China.
Insights
Predicting early recurrence of intussusception after hydrostatic reduction is now possible. A new score uses five clinical and sonographic factors to assess risk, aiding in individualized observation strategies for children.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Clinical Risk Stratification
Background:
- Early recurrence of intussusception after hydrostatic reduction occurs in 5-15% of children, often necessitating repeat interventions.
- Reliable predictors for early recurrence remain incompletely defined, hindering effective risk stratification.
Purpose of the Study:
- To identify clinical and sonographic predictors of early recurrence (within 48 hours) after ultrasound-guided hydrostatic reduction of ileocolic intussusception.
- To develop a weighted nomogram and a simplified bedside score for risk stratification of early recurrence.
Main Methods:
- Retrospective study of 677 children undergoing successful ultrasound-guided hydrostatic reduction.
- LASSO regression and multivariable logistic analysis to identify predictors.
- Construction of a nomogram and a simplified bedside scoring system (0-5 points).
Main Results:
- Five independent predictors identified: transverse colon location, previous intussusception history, target sign diameter >35 mm, peritoneal effusion, and sonographic features of enteritis.
- The nomogram (AUC 0.805) and simplified score (AUC 0.795) demonstrated good discrimination.
- A score cutoff of 3 optimally balanced sensitivity (62.1%) and specificity (84.3%) for recurrence within 48 hours.
Conclusions:
- A weighted nomogram and a simple bedside score accurately predict early recurrence of intussusception after hydrostatic reduction.
- These tools enable individualized risk assessment for pediatric patients.
- Supports risk-stratified observation strategies for children undergoing intussusception reduction.
Objective:
Early recurrence after successful hydrostatic reduction of intussusception occurs in 5-15% of children and often requires repeat intervention, yet reliable predictors remain incompletely defined. To identify clinical and sonographic predictors of early recurrence (within 48 h) after ultrasound-guided hydrostatic reduction of ileocolic intussusception, and to develop a weighted nomogram and a simplified bedside score for risk stratification.
Methods:
This retrospective study included 677 children who underwent successful ultrasound-guided hydrostatic reduction between January 2020 and December 2025. Early recurrence occurred in 66 patients (9.7%). Predictors were identified by LASSO regression and multivariable logistic analysis. A nomogram was constructed, and a simplified scoring system was derived for rapid bedside use. Recurrence timing was analyzed using Kaplan-Meier curves and Spearman's correlation.
Results:
Five independent predictors were identified: transverse colon location (OR 4.647), previous intussusception history (OR 2.831), target sign diameter > 35 mm (OR 1.075 per mm), peritoneal effusion (OR 2.476), and sonographic features of enteritis (OR 2.347). The nomogram showed good discrimination (AUC 0.805). The simplified score (0-5), assigning 1 point to each predictor, also demonstrated acceptable discrimination (AUC 0.795), with a cutoff of 3 points optimally balancing sensitivity (62.1%) and specificity (84.3%). Median recurrence time was 23 h; recurrences were evenly distributed across the 48-h window, and the five predictors did not influence the exact timing of recurrence.
Conclusion:
A weighted nomogram and a simple bedside score based on five clinical and sonographic features accurately predict early recurrence after hydrostatic reduction of ileocolic intussusception. The tools enable individualized risk assessment and support risk-stratified observation strategies.