Risk stratification of children being evaluated for intussusception.
BACKGROUND
Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to bowel perforation.


OBJECTIVE
To determine predictive clinical criteria and develop a decision tree to risk-stratify children with possible intussusception.


METHODS
This is a prospective observational cohort study of children aged 1 month to 6 years who presented with possible intussusception. A data-collection form was completed before knowledge of any advanced imaging. Univariate analysis was performed, and decision trees were developed using recursive partitioning.


RESULTS
In the study, 310 patients were enrolled, including 38 (12.3%) with intussusception. The median age was 21.1 months and 61% were male. Univariate predictors of intussusception included age older than 6 months (P = 0.04), male gender (P = .007), history of lethargy (P = .001), and abnormal plain x-ray (P = .0001). Multivariate analysis through recursive partitioning identified decision trees (with and without the result of a plain abdominal x-ray) and allowed identification of patients at low risk. The decision tree based on the results of an abdominal x-ray (negative or positive), age (≤ 5 or >5 months), diarrhea (present or absent), and bilious emesis (present or absent) had the best test performance (sensitivity: 97% [95% confidence interval (CI): 86-100]; negative predictive value: 99% [95% CI: 93-100]; negative likelihood ratio: 0.08 [95% CI: 0.01-0.6]).


CONCLUSIONS
Among children who were being evaluated for intussusception, we prospectively determined clinical criteria and developed a decision tree to risk-stratify children with possible intussusception.
Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. sweihmiller@gmail.com
Sarah N
SN
Weihmiller
Carlo
C
Buonomo
Richard
R
Bachur
D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003663:Decision Trees; D003967:Diarrhea / Q000150:complications / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007415:Intestinal Obstruction / Q000150:complications / Q000000981:diagnostic imaging; D007443:Intussusception / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D014839:Vomiting / Q000150:complications / Q000000981:diagnostic imaging