Background: Intussusception is the most common cause of intestinal occlusion in young children. It cannot be reliably ruled out with clinical examination and the diagnosis is usually made with ultrasound performed by a radiologist. The primary objective of this study was to derive and validate a clinical decision tool to identify children at risk for intussusception who need an ultrasound among children younger than 5 years old.
Methods This was a prospective cohort study performed in a tertiary care pediatric emergency department. Participants were a convenience sample of children younger than 5 years old who necessitated an abdominal ultrasound for suspected intussusception according to the treating physician. The primary outcome was radiological confirmation of intussusception. A-priori, 24 independent variables were identified through literature review and a consensus of experts. Independent variables were collected prospectively before ultrasound using a standardized research clinical report form. Derivation of the clinical score was performed using multiple variable logistic regression among the participants after the recruitment of 50 cases of intussusception. Then, a second sample including at least 25 patients with an intussusception was used to measure predictive ability of the score using ROC curve (validation phase).
Results: A total of 238 children fulfilled the inclusion/exclusion criteria and were recruited during the derivation (n=175; 50 cases) and validation (n=63; 25 cases) phases. Using a multivariate model, a risk score was derived and includes 4 clinical criteria: age less than 36 months old, presence of vomiting, abdominal mass and hypotonia on physical exam. This score stratifies patients at low, moderate or high risk. When applied to the validation study population the score showed moderate predictive ability with an area under the ROC curve of 0.63 (95%CI: 0.49 To 0.77).
Conclusion: We derived a clinical decision score to stratify the risk of intussusception among young children with clinical suspicion of intussusception. Using this score will improve resources utilisation for suspicion of intussusception.