Am J Emerg Med. 2025 Nov 24;100:96-106. doi: 10.1016/j.ajem.2025.11.024. Online ahead of print.
OBJECTIVE: To identify independent risk factors for failure of hydrostatic enema reduction in children with primary intussusception and to develop and validate a nomogram for early prediction.
METHODS: A retrospective cohort study was conducted on 481 pediatric in-patients with confirmed intussusception who underwent ultrasound-guided hydrostatic enema reduction at Lianyungang First People’s Hospital between January 2021 and December 2024. Patients were divided into a successful-reduction group (n = 434) and a failed-reduction group (n = 47). Demographic data, clinical manifestations, and ultrasonographic findings were extracted. Univariate analyses (independent-samples t-test, χ2 test, and Mann-Whitney U test) were performed to compare the two groups. Variables with P < 0.05 were entered into a multivariable binary logistic regression model to determine independent predictors of failure. A nomogram was constructed based on the regression coefficients, and its discriminative performance was assessed by the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrapping; an external validation cohort (n = 73) enrolled between January 2025 and August 2025 was used to confirm generalizability.
RESULTS: Multivariable analysis revealed seven independent predictors of enema-reduction failure: age 3 mm. The nomogram achieved an AUC of 0.901 (95 % CI: 0.862-0.941) in the derivation cohort and 0.929 (95 % CI: 0.866-0.991) in the external validation cohort. Calibration curves demonstrated excellent agreement between predicted and observed probabilities; decision-curve analysis indicated substantial clinical net benefit.
CONCLUSIONS: Age < 1 year, vomiting, prolonged symptom duration, large target mass, transverse-colon location, compromised mural perfusion, and marked bowel-wall edema are significant risk factors for failure of hydrostatic enema reduction in pediatric intussusception. The proposed nomogram exhibits robust predictive performance and may facilitate risk stratification, timely surgical consultation, and optimization of treatment strategies.
PubMed:41317462 | DOI:10.1016/j.ajem.2025.11.024