A retrospective analysis of risk factors for intestinal necrosis in pediatric secondary intussusception

OBJECTIVE: This study aimed to identify risk factors of intestinal necrosis in pediatric patients with secondary intussusception, in order to inform clinical strategies for early and timely intervention in high-risk patients. METHODS: A retrospective analysis was conducted on 92 children treated from October 2018 to October 2023. Descriptive comparisons were made for sex, hematochezia, and symptom duration. Firth logistic regression was used to evaluate the main and interaction effects of age and etiology. A prediction model and a simplified bedside scoring system were developed and validated using ROC analysis. RESULTS: Among 92 children, intestinal necrosis occurred in 17 (18.5%). In multivariable Firth logistic regression including etiology and age, IgA vasculitis (IgAV) (OR 7.31, p = 0.005) and Meckel's diverticulum (MD) (OR 4.43, p = 0.045) showed independent associations with necrosis, whereas age (per year) was not independently significant (p = 0.400). Age significantly modified the IgAV-necrosis association (IgAV×Age interaction OR = 0.416, p = 0.001); within IgAV, each additional year of age was associated with ≈ 29% lower odds of necrosis (per-year OR ≈ 0.72). The interaction-based model achieved AUC 0.847 on internal validation. A simplified 0-4 score (AUC 0.735) stratified necrosis risk into three bands: ≤1 (5% necrosis; NPV 95%), 2-3 (22.5% necrosis; intermediate-risk), and = 4 (50% necrosis; PPV 50%, specificity 92%) at the observed prevalence of 18.5%. CONCLUSION: The risk of necrosis is significantly higher in intussusceptions secondary to IgAV and probably even higher in the younger child. External validation in broader cohorts is needed.