Department of Pediatrics, Women's and Children's Hospital, Chongqing Medical University, 120 Longshan Rd., Chongqing, 401147, P.R. China.
Department of Pediatrics, Yongchuan maternal and Child Health Hospital, Chongqing, P.R. China.
BMC Gastroenterol. 2024 May 22;24(1):180. doi: 10.1186/s12876-024-03243-6.
Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients.
This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (β).
Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03-5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76-48.75, P < 0.001), elevated C-reactive protein levels (OR = 4.79; 95% CI, 1.12-28.31, P = 0.0072), lactate clearance rate (LCR) (OR = 17.25; 95% CI, 2.36-80.35; P < 0.001), and the intussusception location (OR = 12.65; 95% CI, 1.46-62.67, P < 0.001), as determined by multivariate logistic regression analysis. A scoring system (totaling 14.02 points) was developed from the cumulative β coefficients, with a threshold of 5.22 effectively differentiating infants requiring surgical intervention from others with necrotizing enterocolitis (NEC), exhibiting a sensitivity of 78.3% and a specificity of 71.9%.
This study successfully identified multiple risk factors for bowel resection and effectively used a scoring system to identify patients for optimal clinical management.
肠套叠是一种严重的急症，常需进行肠切除术，导致严重的并发症和管理挑战。本研究旨在探讨并建立一种评分系统，以提高对小儿肠套叠患者肠切除必要性的预测能力。
本回顾性研究分析了 2008 年 4 月至 2020 年 12 月在中国西南部一家儿童医院接受手术治疗的 660 例住院肠套叠患儿。对该队列中的肠切除术必要性进行评估和分类。使用单因素和多因素逻辑回归分析检查与肠切除术相关的变量。基于这些分析，建立了一个评分系统，该系统基于系数（β）的总和。
在符合纳入标准的 660 例患者中，218 例在手术中需要肠切除术。肠切除的发生与症状持续时间延长（比值比[OR] = 2.14；95%置信区间[CI]，1.03-5.23；P = 0.0015）、存在大量血性粪便（OR = 8.98；95%CI，1.76-48.75，P < 0.001）、C 反应蛋白水平升高（OR = 4.79；95%CI，1.12-28.31，P = 0.0072）、乳酸清除率（LCR）（OR = 17.25；95%CI，2.36-80.35；P < 0.001）和肠套叠位置（OR = 12.65；95%CI，1.46-62.67，P < 0.001）有关，这是通过多因素逻辑回归分析确定的。从累积β系数中开发了一个评分系统（总计 14.02 分），阈值为 5.22，可有效区分需要手术干预的婴儿和患有坏死性小肠结肠炎（NEC）的婴儿，敏感性为 78.3%，特异性为 71.9%。
本研究成功确定了肠切除的多个危险因素，并有效地使用评分系统来识别患者，以进行最佳的临床管理。
