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
ARTICLE HIGHLIGHTS
Research background

Intussusception is the most common cause of intestinal obstruction in young children. Bowel infarction and perforation, leading to peritonitis and death, are the more serious complications of late or missed diagnoses. Abdominal ultrasonography (USG) is the gold standard of investigation, but these procedures require an experienced radiologist and timely availability of the USG machine that is often limited.

Research motivation

To develop a user-friendly tool that could help front-line doctors diagnose intussusception in resource limited areas to improve clinical case management.

Research objectives

The present study aimed to study the demographic data, disease characteristics, and management of children with suspected intussusception, and to describe the user-friendly parameters that are helpful for general physicians to diagnose intussusception.

Research methods

Medical records of 151 children, aged less than 18 years, who had clinically suspected intussusception and had completed abdominal radiography (AR) and abdomen USG procedures as part of the work-up during evaluation by pediatric residents at King Chulalongkorn Memorial Hospital from January 2006 to June 2018 were included in the present study. Diagnostic sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated for AR with and without promising parameters to diagnose intussusception. USG is considered the gold standard to diagnose intussusception.

Research results

One hundred and fifty-one children with suspected intussusception were included in the study with a mean age of 2.47 ± 3.09 years, with 64.2% of them were male. Characteristics that could discriminate intussusception from non-intussusception included children aged 6 mo to 2 years old, pallor, abdominal mass, and positive AR (P < 0.05). AR images (n = 133) were interpreted blindly by a pediatric radiologist and had a sensitivity, specificity, PPV, and NPV to diagnose intussusception of 59.2%, 70.9%, 78.4%, and 49.4%, respectively. Promising parameters including common age group, common manifestations (abdominal pain or irritability, vomiting, and abdominal distension), significant manifestations that could discriminate intussusception and other mimic diseases (pallor and palpable mass), and AR images were chosen and combined to establish models that could help general physicians to identify suspected intussusception prior to timely confirmation by abdomen USG. The combination of the user-friendly triad (children aged 6 mo to 2 years old, abdominal pain or irritability, and AR) that we termed the “Pediatric Intussusception Score” showed diagnostic value for intussusception with a sensitivity of 85.7% and an area under the receiver operating characteristic curve of 0.704 (95% confidence interval: 0.616-0.790).

Research conclusions

AR is considered a poor diagnostic tool for intussusception. It is operator independent and front-line doctors in rural areas can use this tool to identify suspected cases of intussusception. Positive AR could help the doctor to decide which cases to refer to secondary or tertiary hospitals for specific and timely management in time. Two clinical parameters that doctors should be aware with intussusception were integrated into the PIS. The PIS will help young doctors have confidence to make initial diagnoses of intussusception.

Research perspectives

Further study to validate the PIS for the diagnosis of intussusception is warranted.