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Pediatrics. 2011 Feb;127(2):e296-303. doi: 10.1542/peds.2010-2432. Epub 2011 Jan 17.

Risk stratification of children being evaluated for intussusception.

Author information

1
Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, USA. sweihmiller@gmail.com

Abstract

CONTEXT:

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.

DESIGN/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.

PMID:
21242220
DOI:
10.1542/peds.2010-2432
[Indexed for MEDLINE]

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