Is enema reduction in pediatric intussusception with a history of over 48 h safe: A retrospective cohort study

Liu, Shu Ting; Li, Yi Feng; Wu, Qian; Ma, Xin; Bai, Yu

doi:10.1016/j.ajem.2023.02.027

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…The study results were consistent with the findings of previous studies, indicating that a longer duration of illness was more common in patients with intestinal necrosis (7,11,12,14,(19)(20)(21). Longer duration of symptoms before presentation is related to an increase in the loss of intestinal viability (18).…”

Section: Discussionsupporting

confidence: 91%

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

Yu,

Zhang,

et al. 2024

Front. Pediatr.

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PurposeDevelop and validate a nomogram for predicting intestinal resection in pediatric intussusception suspecting intestinal necrosis.Patients & methodsChildren 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.ResultsA 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).ConclusionWe 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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Section: Discussionsupporting

confidence: 91%

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

Yu,

Zhang,

et al. 2024

Front. Pediatr.

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“…However, Lim et al’s 28 retrospective study, conducted at a tertiary referral center in Malaysia, found no correlation between symptom duration, clinical manifestations such as blood in the stool and vomiting, and the success of ultrasound-guided enterointussusception water enema in children. Liu et al 29 also concluded that there was no statistical difference in the success rate of ultrasound-guided hydrostatic enema between children with a disease duration of more than 48 hours and those with a duration of less than 48 hours. Our study indicates that a longer duration of abdominal pain (with a cut-off value of 24.5 hours) is a risk factor for enema failure, meaning that children with a duration exceeding 24.5 hours are more likely to require surgery.…”

Section: Discussionmentioning

confidence: 99%

Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China

Liu,

Wang,

Jiang

et al. 2024

TCRM

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Purpose The objective of this study was to develop and validate a nomogram for predicting the need for surgical intervention in pediatric intussusception after pneumatic reduction. Patients and Methods This retrospective study analyzed the clinical data of children with acute intussusception admitted to four hospitals in China from January 2019 to January 2022. Based on the results of pneumatic reduction, the patients were divided into two groups: the successful reduction group (control group) and the failed reduction group (operation group). The total sample was randomly divided into a training set and a validation set in a 7:3 ratio. Logistic regression analysis was performed to establish a predictive model for surgical risk. Results A total of 1041 samples were included in this study, with 852 in the control group and 189 in the operation group. Among the total sample, 728 cases were used for training and 313 cases were used for validation. Logistic regression analysis of the training set identified age, time of abdominal pain, presence or absence of hematostoecia, C-reactive protein value from blood test on admission, and nested position indicated by B-ultrasound as independent predictors of intussusception intervention. Based on the five independent risk factors identified through multivariate logistic regression, a nomogram was successfully constructed to predict the failure of resetting by air enema under X-ray. Conclusion A nomogram was developed to predict the need for surgical intervention after intussusception pneumatic reduction in children. The nomogram was based on clinical risk factors including age, time of abdominal pain, presence or absence of blood in stool, value of C-reactive protein in blood test on admission, and nested position indicated by B-ultrasound. Our internal validation demonstrated that this nomogram can serve as a useful tool for identifying risk factors associated with failure of air enema in children with intussusception.

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“…Reported success of fluoroscopic reduction of ileocolic intussusception ranges between 74 and 98% [ 1 , 2 , 9 , 12 , 14 , 16 ]. Our fluoroscopic reduction success frequency was in this range for both groups.…”

Section: Discussionmentioning

confidence: 99%

“…Liu et al compared patients with a history of symptoms for more than 48 h to patients with symptoms for less than 48 h. They found no differences in success, recurrence, or perforation frequencies. They also found that the presence of bloody stools had a non-significant trend toward less successful reductions [ 12 ]. This conflicts with previously published articles.…”

Section: Discussionmentioning

confidence: 99%

Impact of a 6–12-h delay between ileocolic intussusception diagnostic US and fluoroscopic reduction on patients’ outcomes

Lopez-Rippe,

Davis,

Dennis

et al. 2024

Pediatr Radiol

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Background Image-guided reduction of intussusception is considered a radiologic urgency requiring 24-h radiologist and technologist availability. Objective To assess whether a delay of 6–12 h between US diagnosis and fluoroscopic reduction of ileocolic intussusception affects the success frequency of fluoroscopic reduction. Materials and methods Retrospective review of 0–5-year-olds undergoing fluoroscopic reduction for ileocolic intussusception from 2013 to 2023. Exclusions were small bowel intussusception, self-reduced intussusception, first fluoroscopic reduction attempt>12 h after US, prior bowel surgery, inpatient status, and patient transferred for recurrent intussusception. Data collected included demographics, symptoms, air/contrast enema selection, radiation dose, reduction failure, 48-h recurrence, surgery, length of stay, and complications. Comparisons between<6-h and 6–12-h delays after ultrasound diagnosis were made using chi-square, Fisher’s exact test, and Mann–Whitney U tests (P< 0.05 considered significant). Results Of 438 included patients, 387 (88.4%) were reduced in <6 h (median age 1.4 years) and 51 (11.7%) were reduced between 6 and 12 h (median age 2.05 years), with median reduction times of 1:42 and 7:07 h, respectively. There were no significant differences between the groups for reduction success (<6 h 87.3% vs. 6–12 h 94.1%; P-value = 0.16), need for surgery (<6 h 11.1% vs. 6–12 h 3.9%; P-value=0.112), recurrence of intussusception within 48 h after reduction (<6 h 9.3% vs. 6–12 h 15.7%; P-value=0.154), or length of hospitalization (<6 h 21:07 h vs. 6–12 h 20:03 h; P-value=0.662). Conclusion A delay of 6–12 h between diagnosis and fluoroscopic reduction of ileocolic intussusception is not associated with reduced fluoroscopic reduction success, need for surgical intervention after attempted reduction, recurrence of intussusception following successful reduction, or hospitalization duration after reduction. Graphical Abstract

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Is enema reduction in pediatric intussusception with a history of over 48 h safe: A retrospective cohort study

Cited by 4 publications

References 25 publications

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

Developing and validating a nomogram for early predicting the need for intestinal resection in pediatric intussusception

Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China

Impact of a 6–12-h delay between ileocolic intussusception diagnostic US and fluoroscopic reduction on patients’ outcomes

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