Paediatric Intussusception: A Clinical Scoring System to Predict the Risk of Operative Intervention

Tiwari, Charu; Shah, Hemanshi; Sandlas, Gursev; Bothra, Jyoti

doi:10.34763/jmotherandchild.2020241.1934.000002

Abstract

Background

Intussusception is a common cause of obstruction in paediatric patients. Rapid clinical recognition and treatment is important to prevent potentially fatal complications. The present study aims to derive a clinical scoring system for prediction of risk of operative intervention in patients with intussusception.

Materials and methods

Data of 100 patients with intussusception were analyzed retrospectively, and a score was calculated based on clinical parameters – age, presence/absence of symptoms and signs such as abdominal distention, vomiting, lump abdomen, red currant jelly stools and duration of abdominal pain. The maximum score was 12, and the minimum score was 6. This score was then applied to other 50 consecutive patients with intussusception.

Results

Of 100, 13 patients required operative intervention; 87 patients were managed by hydrostatic reduction. In all, four patients with a score of 12 and five patients with a score of 11 required operative intervention. Seven patients had a score of 10, out of which four (57.14%) required operative intervention. A total of 87 patients who had a score of 10 or less were successfully managed non-operatively by ultrasound-guided hydrostatic reduction. In the next 50 patients, two patients with a score of 9 and all patients with scores of 10 and 11 required operative intervention. Thus, age less than 3 months and more than 2 years, presence of symptoms such as abdominal lump, red currant jelly stools and duration of abdominal pain of 2 or more days were strong predictors of operative intervention.

Conclusion

This clinical score helps to predict the risk of operative intervention required in a child with a diagnosis of intussusceptions – duration of abdominal pain of 48 h or more, presence of abdominal distention and lump and red currant jelly stools are strong predictors of need of operative intervention in patients with intussusception. Higher the score (8 or more, as concluded by this study), more the probability of requiring operative intervention in these patients. Though limited, this study could serve as a pilot work to develop a user-friendly score for early surgical decision making in the management of paediatric intussusception.

References

Fallat ME. Intussusception. p. 518–526. In: Ashcraft KW, Murphy JP, Sharp RL, Sigalet DL, Snyder CL. Pediatric surgery. 3rd ed. Philadelphia, Pennsylvania: W.B. Saunders Company; 2000; 1091 p. ISBN: 978-0721673127.
Search in Google Scholar Back to article
Columbani PM, Scolz S. Chapter 85 - Intussusception. p. 1093–1110. In: Pediatric surgery. Coran AG, Caldamone A, Adzick NS, Krummel TM, Laberge J-M, Shamberger R, editors. 7th ed. Mosby, Elsevier Inc; 2012; 848 p. ISBN 978-0-323-07255-7.
Search in Google Scholar Back to article
Young DG. Intussusception. p. 1185–1198. In: O’Neil JA Jr, Rowe MI, Grosfeld JL, Fonkalsrud EW, Coran AG, editors. Pediatric surgery. 5th ed. New York, USA: Mosby; 1998; 1981 p. ISBN: 978-0815165187.
Search in Google Scholar Back to article
Fallon SC, Lopez ME, Zhang W, Brandt ML, Wesson DE, Lee TC, et al. Risk factors for surgery in pediatric intussusception in the era of pneumatic reduction. J Pediatr Surg. 2013;48(5):1032–6. doi: 10.1016/j.jpedsurg.2013.02.021.
Open DOI Search in Google Scholar Back to article
Dennison WM. Acute intussusception in infancy and childhood. Glasgow Med J. 1948;29(3):71–80.
Search in Google Scholar Back to article
Khorana J, Singhavejsakul J, Ukarapol N, Laohapensang M, Wakhanrittee J, Patumanond J. Enema reduction of intussusception: the success rate of hydrostatic and pneumatic reduction. Ther Clin Risk Manag. 2015;11:1837–42. doi: 10.2147/TCRM.S92169.
Open DOI Search in Google Scholar Back to article
Bekdash B, Marven SS, Sprigg A. Reduction of intussusception: defining a better index of successful non-operative treatment. Pediatr Radiol. 2013;43(6):649–956. doi: 10.1007/s00247-012-2552-6.
Open DOI Search in Google Scholar Back to article
Tareen F, Ryan S, Avanzini S, Pena V, Mc Laughlin D, Puri P. Does the length of the history influence the outcome of pneumatic reduction of intussusception in children? Pediatr Surg Int. 2011;27(6):587–9. doi: 10.1007/s00383-010-2836-6.
Open DOI Search in Google Scholar Back to article
Ramachandran P, Gupta A, Vincent P, Sridharan S. Air enema for intussusception: is predicting the outcome important? Pediatr Surg Int. 2008;24(3):311–3. doi: 10.1007/s00383-007-2101-9.
Open DOI Search in Google Scholar Back to article
Fragoso AC, Campos M, Tavares C, Costa-Pereira A, Estevão-Costa J. Pneumatic reduction of childhood intussusception. Is prediction of failure important? J Pediatr Surg. 2007;42(9):1504–8. doi: 10.1016/j.jpedsurg.2007.04.013.
Open DOI Search in Google Scholar Back to article
Lehnert T, Sorge I, Till H, Rolle U. Intussusception in children – clinical presentation, diagnosis and management. Int J Colorectal Dis. 2009;24(10):1187–92. doi: 10.1007/s00384-009-0730-2.
Open DOI Search in Google Scholar Back to article
Katz M, Phelan E, Carlin JB, Beasley SW. Gas enema for the reduction of intussusception: relationship between clinical signs and symptoms and outcome. AJR Am J Roentgenol. 1993;160(2):363–6. doi: 10.2214/ajr.160.2.8424351.
Open DOI Search in Google Scholar Back to article
Fike FB, Mortellaro VE, Holcomb GW 3rd, St Peter SD. Predictors of failed enema reduction in childhood intussusception. J Pediatr Surg. 2012;47(5):925–7. doi: 10.1016/j.jpedsurg.2012.01.047.
Open DOI Search in Google Scholar Back to article