Risk factors and the establishment of nomogram model for failure of air enema reduction in children with Ileocolic Intussusception

Abstract

Abstract Objective: This study aims to identify the risk factors associated with the failure of air enema reduction in children diagnosed with Ileocolic Intussusception, and subsequently develop a nomogram model to predict the likelihood of this failure. Method:The retrospective analysis involved the examination of clinical data from 502 children diagnosed with intussusception who were admitted to the Children's Surgery Center of the First People's Hospital of Zigong City, Sichuan Province between June 2017 and June 2022. Out of these cases, 87 (17.3%) experienced failure in air enema reduction, while 100 cases (19.9%) required surgical intervention. Univariate and multivariate analyses were conducted to identify the risk factors associated with air enema reduction failure in children. Additionally, a nomogram was developed to establish a risk assessment model for predicting the likelihood of air enema reduction failure. Receiver operating characteristic curve (ROC) and AUC values were used to evaluate the accuracy of the model. Results: The findings from the Univariate analysis indicate that several factors, including overweight, abdominal mass, abdominal distension, location of intussusception, length and diameter of intussusception, ileocecal valve edema, frequency of enema, and pathological factors, are significantly associated with the failure of intussusception air enema reduction in children (p < 0.05). The results of the multivariate analysis indicated that several factors were found to be independent risk factors for the failure of air enema reduction in children. These factors included overweight (OR=4.02, 95%CI 2.15-7.51, P < 0.001), location of intussusception (OR=3.39, 95%CI 1.31-8.77, P=0.012), times of enema (OR=2.18, 95%CI 1.27-3.77, P=0.005), and pathological factors (OR=2.54, 95%CI 1.17-5.49, P=0.018). The risk assessment model's nomogram had a total score of 260 points, and the area under the curve (AUC) value of the nomogram was 0.743. Conclusion The failure of air enema in children can be attributed to various risk factors, including overweight, location of intussusception, the timing of enema, and pathological factors. Furthermore, the risk assessment model that has been developed exhibits promising clinical predictive capabilities.