Therapeutics and Clinical Risk Management (May 2024)
Developing a Nomogram for Predicting Surgical Intervention in Pediatric Intussusception After Pneumatic Reduction: A Multicenter Study from China
Abstract
Jie Liu,1,2,* Yongkai Wang,3,* Zhihui Jiang,4,* Guangqi Duan,1 Xiaowen Mao,5 Danping Zeng2 1Department of Pediatric Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 2Department of General Surgery and Urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, Nanning, People’s Republic of China; 3Department of Hepatobiliary Surgery, Yijishan Hospital of Wannan Medical College, Wannan Medical College, Wuhu, People’s Republic of China; 4Department of General Surgery, Qingdao Women and Children’s Hospital, Qingdao, People’s Republic of China; 5Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Danping Zeng, Department of General surgery and urology, Maternal and Child Health Hospital/Obstetrics and Gynecology Hospital of Guangxi Zhuang Autonomous Region, No. 225, Xinyang Road, Nanning City, Guangxi Zhuang Autonomous Region, 530003, People’s Republic of China, Email [email protected] Xiaowen Mao, Department of Pediatric Surgery, Maternal and Child Health Hospital of Hubei, Tongji Medical College, Huazhong University of Science and Technology, 746 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, 430070, People’s Republic of China, Email [email protected]: 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.Keywords: pediatric, intussusception, pneumatic reduction, nomogram, surgical intervention
