Scoring System to Evaluate Risk of Nonoperative Management Failure in Children With Intussusception.

ABSTRACT

INTRODUCTION: Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention. METHODS: Children diagnosed with intussusception upon presentation to the emergency department of a tertiary children's hospital between 2019 and 2022 were retrospectively identified. Univariable logistic regression identified predictors of nonoperative failure used as starting covariates for multivariable logistic regression with final model determined by backwards elimination. Regression coefficients for final predictors were used to create the scoring system and optimal cut-points were delineated. RESULTS: We identified 143 instances of ultrasound-documented intussusception of which 28 (19.6%) required operative intervention. Predictors of failed nonoperative management included age ≥4 y (odds ratio [OR] 32.83, 95% confidence interval [CI] 1.91-564.23), ≥1 failed enema reduction attempts (OR 189.53, 95% CI 19.07-1884.11), presenting heart rate ≥128 (OR 3.38, 95% CI 0.74-15.36), presenting systolic blood pressure ≥115 mmHg (OR 6.59, 95% CI 0.93-46.66), and trapped fluid between intussuscepted loops on ultrasound (OR 17.54, 95% CI 0.77-397.51). Employing these factors, a novel risk scoring system was developed (area under the curve 0.96, 95% CI 0.93-0.99). Scores range from 0 to 8; ≤2 have low (1.1%), 3-4 moderate (50.0%), and ≥5 high (100%) failure risk. CONCLUSIONS: Using known risk factors for enema failure, we produced a risk scoring system with outstanding discriminate ability for children with intussusception necessitating surgical intervention. Prospective validation is warranted prior to clinical integration.