Scoring system to predict the failure of hydrostatic reduction for children with intussusception: a single center study

Intussusception is a common cause of intestinal obstruction in pediatric patients. Early recognition and treatment are essential to prevent potentially fatal complications. Identifying the risk of failure of hydrostatic reduction as non-operative management in children with intussusception would provide significant clinical advantages. It would allow prompt identification of the need for early surgical intervention and potentially prevent complications that can arise from prolonged intestinal strangulation. To address this issue, our study proposed a scoring system that evaluates the likelihood of hydrostatic reduction failure in pediatric intussusception cases. The medical records of 61 children with intussusception who underwent hydrostatic reduction were analyzed retrospectively to determine a scoring system using the following variables: age, weight, vomiting, duration of symptoms, currant jelly stool, abdominal distention, mass location, and pseudoportio sign. Among the 61 eligible patients, hydrostatic reduction was successful in 23 (37.7%) and failed in 38 (62.3%). There was a significant association between the failure of hydrostatic reduction with age ≤12 months (p=0.002), body weight ≤10 kg (p=0.001), vomiting (p=0.0006), duration of symptoms >48 hours (p=0.003), abdominal distension (p=0.001), location of mass (p=0.00004), currant jelly stool (p=0.00005), and pseudoportio sign (p=0.001). Multivariate analysis showed that the onset of symptoms >48 hours (p=0.014; OR=17.34 [95% CI=1.76-170.45]), left-sided mass (p=0.003; OR=17.74 [95% CI=2.66-118.17]), and currant jelly stool (p=0.029; OR=9.05 [95% CI=1.26-65.03]) were strongly associated with failure of hydrostatic reduction. Prediction scores ranged from 0 to 3. A score of ≥2 predicted a higher possibility of reduction failure, while a score of <2 predicted a lower possibility of reduction failure (p<0.000). The scoring system might serve as a valuable prognostic tool for pediatric surgeons in evaluating the risk of hydrostatic reduction failure in children with intussusception. Our findings indicate that three critical indicators—the duration of symptoms exceeding 48 hours, the presence of currant jelly stool, and a left-sided mass of the abdomen—are associated with the failure of hydrostatic reduction. This scoring system may facilitate patients' decision-making and guide the need for early surgical intervention.