title: Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception.
abstract: BACKGROUND
  Intestinal necrosis is the most serious complication of intussusception. The risk factors associated with intestinal necrosis in pediatric patients with intussusception have not been well characterized.
  
  
  OBJECTIVE
  This study aimed to investigate the risk factors associated with intestinal necrosis in pediatric patients with failed non-surgical reduction for intussusception.
  
  
  METHODS
  Hospitalized patients who failed the air-enema reduction for intussusception in the outpatient department and subsequently underwent surgery were retrospectively reviewed. All cases were categorized into two groups: intestinal necrosis group and non-intestinal necrosis group based on the surgical findings. Demographic and clinical features including the findings from the surgery were recorded and analyzed. Factors associated with intestinal necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses.
  
  
  RESULTS
  A total of 728 cases were included. Among them, 171 had intestinal necrosis at the time of surgery. The group with intestinal necrosis had a longer duration of symptom or length of illness (P = 0.000), and younger (P = 0.000) than the non-intestinal necrosis group. Complex/compound type of intussusceptions is more likely to have intestinal necrosis. Multivariate analysis showed that the presence of grossly bloody stool (OR = 2.12; 95% CI 1.19-3.76, P = 0.010) and duration of symptom (OR = 1.07; 95% CI 1.06-1.08, P = 0.000) were independent risk factors for intestinal necrosis in patients hospitalized for surgical reduction for intussusceptions.
  
  
  CONCLUSIONS
  At time of admission, the presence of bloody stools and duration of symptom are the important risk factors for developing intestinal necrosis for those patients who failed non-surgical reduction. The length of illness has the highest sensitivity and specificity to correlate with intestinal necrosis. This finding may suggest that we should take the intussusception cases that have the longer duration of symptom directly to operation room for reduction.
authors.affiliation: Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, China.
authors.forename: Hui-Ya
authors.initials: HY
authors.lastname: Huang
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
authors.forename: Xiao-Zhong
authors.initials: XZ
authors.lastname: Huang
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
authors.forename: Yi-Jiang
authors.initials: YJ
authors.lastname: Han
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
authors.forename: Li-Bin
authors.initials: LB
authors.lastname: Zhu
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
authors.forename: Kai-Yu
authors.initials: KY
authors.lastname: Huang
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China. jing.lin@mssm.edu.|Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA. jing.lin@mssm.edu.
authors.forename: Jing
authors.identifier: http://orcid.org/0000-0002-4405-134X
authors.initials: J
authors.lastname: Lin
authors.affiliation: The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, 325027, China. wmclzr@163.com.
authors.forename: Zhong-Rong
authors.initials: ZR
authors.lastname: Li
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007422:Intestines / Q000473:pathology* / Q000601:surgery; D007443:Intussusception / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D009336:Necrosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Iintestinal necrosis; Intussusception; Pediatrics; Risk factors