Prediction of Ultrasound Guided Hydroreduction In Pediatric Intussusception Using Clinical Prediction Score

Abstract

Context: Intussusception is a common disorder of children. The current treatment modality is non operative procedure either by pneumatic reduction or saline hydroreduction. The failure of hydroreduction is one of the disadvantages of non operative reduction. Clinical prediction score (CPS) has been designed by Khorana to predict the success or failure of non operative reduction. Aims: The present study aims to identify the risk factors for the success or failure of saline hydroreduction. Settings and Design: This is a prospective observational study conducted in a University Hospital in Kathmandu, Nepal. Methods and Material: All children with intussusception were subjected to hydroreduction unless contraindicated. The outcome of hydroreduction was measured as ‘Successful’ or Unsuccessful’ after the procedure. Clinical characteristics, ultrasound findings, and investigation results were compared between ‘Successful’ and Unsuccessful’ groups. The accuracy of CPS for prediction of success was calculated. Results: A total of 54 children underwent hydroreduction, among whom 47 (87%) were successful while 7 (13%) were unsuccessful. No patients developed complications. Rectal bleeding, fever and abdominal distension were significantly different between successful and unsuccessful groups. CPS was found to have a significant prediction of outcome for saline hydroreduction (P < .001). At a cut-off score of 11, sensitivity, specificity, positive predictive value, negative predictive value were 96%, 86%, 98% and 75% respectively. Conclusions: Rectal bleeding, fever and abdominal distension were independent risk factors for the failure of hydroreduction. CPS was a good predictor of the outcome of saline hydroreduction. Key Messages: Hydroreduction is a standard procedure for pediatric intussusceptions. Failure of reduction is a major concern of the procedure. This study focuses different parameters for outcome of hydroreduction. Rectal bleeding, fever and abdominal distension were found as significant predictor of failure of hydroreduction. Keywords: Intussusception; Hydroreduction; Risk factors; Clinical Prediction Score.