Khorana et al reported a model for predicting failure of nonoperative intussusception reduction. The authors are from multiple institutions in Thailand.
Patient selection: pediatric patient with intussusception, age 0 to 15 years, with no contraindication to nonoperative reduction
Parameters:
(1) body weight in kilograms
(2) duration of symptoms in hours
(3) vomiting
(4) rectal bleeding
(5) abdominal distention
(6) temperature in °C
(7) palpable mass
(8) location
(9) ultrasound showing poor prognostic findings (thick peripheral hypoechoic rim, free intraperitoneal fluid, fluid trapped within the intussusception, enlarged lymph node, pathologic leading point and/or absence of blood flow in the intussusception)
(10) method of reduction (pressure enema under ultrasound or fluoroscopy)
|
Parameter
|
Finding
|
Points
|
|
body weight
|
<= 12 kg
|
2
|
|
|
> 12 kg
|
0
|
|
duration of symptoms
|
<= 48 hours
|
0
|
|
|
> 48 hours
|
1
|
|
vomiting
|
no
|
0
|
|
|
yes
|
2
|
|
rectal bleeding
|
no
|
0
|
|
|
yes
|
2
|
|
abdominal distention
|
no
|
0
|
|
|
yes
|
2
|
|
temperature
|
<= 37.8°C
|
0
|
|
|
> 37.8°C
|
2
|
|
palpable mass
|
no
|
0
|
|
|
yes
|
1
|
|
location
|
right-sided
|
0
|
|
|
left-sided
|
2
|
|
US poor prognosis
|
no
|
0
|
|
|
yes
|
1
|
|
method of reduction
|
pneumatic
|
0
|
|
|
hydrostatic
|
1
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• A score >= 12 is associated with a high risk for reduction failure (positive likelihood ratio 18.2; greater than 80%).
• A score <=6 has a low risk of failed reduction (less than 20%).
Performance:
• The area under the ROC curve is 0.81.
