Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2023; 11(21): 5014-5022
Published online Jul 26, 2023. doi: 10.12998/wjcc.v11.i21.5014
Cohort analysis of pediatric intussusception score to diagnose intussusception
Punwadee Rukwong, Nathawit Wangviwat, Teerasak Phewplung, Palittiya Sintusek
Punwadee Rukwong, Department of Pediatrics, Phrapokklao Hospital, Chantaburi 22000, Meuang, Thailand
Nathawit Wangviwat, Division of Laboratory Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
Teerasak Phewplung, Department of Radiology, Chulalongkorn University, Bangkok 10330, Thailand
Palittiya Sintusek, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok 10330, Thailand
Author contributions: Rukwong P and Sintusek P designed the study; Rukwong P collected all the data; Phewplung T analyzed and interpreted the abdominal X-ray; Rukwong P, Wangviwat N, and Sintusek P analyzed and interpreted the data; Rukwong P and Sintusek P wrote the manuscript; Sintusek P was responsible for editing and revising the manuscript; Sintusek P revised the manuscript for intellectual content; all authors approved the final version of the manuscript.
Supported by Thailand Science Research and Innovation Fund Chulalongkorn University, No. HEA663000047.
Institutional review board statement: This study was approved by the Institutional Review Board of Chulalongkorn University (IRB number: 515/60).
Informed consent statement: This is a retrospective data and no informed consent is required.
Conflict-of-interest statement: All the authors have no conflict of interest to disclose.
Data sharing statement: Data will be shared when investigators contact the corresponding author.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Palittiya Sintusek, MD, PhD, Associate Professor, Thai Pediatric Gastroenterology, Hepatology and Immunology Research Unit, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, Chulalongkorn University, 1873 Rama IV, Pathumwan, Bangkok 10330, Thailand. palittiya.s@chula.ac.th
Received: March 16, 2023
Peer-review started: March 16, 2023
First decision: June 12, 2023
Revised: June 18, 2023
Accepted: June 27, 2023
Article in press: June 27, 2023
Published online: July 26, 2023
Processing time: 132 Days and 11.2 Hours
Abstract
BACKGROUND

Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas.

AIM

To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS).

METHODS

Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated.

RESULTS

Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%.

CONCLUSION

AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.

Keywords: Intussusception; Pediatric; Specificity; Sensitivity; Abdominal radiography; Diagnosis

Core Tip: Intussusception is the most common cause of intestinal obstruction in young children. Early diagnosis and prompt management can lead to favorable outcomes. Ultrasonography is considered the gold standard for diagnosis, while abdominal radiography is typically used as the initial imaging study in suspicious cases. The present study found that AR had a sensitivity of 59.2%, but the sensitivity increased to 85.7% when in combination with data on clinical irritability, abdominal pain, and age. Pediatric intussusception score might be a helpful tool for general physicians or pediatricians in limited resource settings for early diagnosis and timely referral to increase favorable outcomes.