Predictors of intussusception in young children

Objective: To identify predictors of intussusception in young children. Design: A retrospective cross-sectional study. Setting and Patients: A consecutive sample of children younger than 5 years on whom contrast enemas were performed because of suspected intussusception seen at an urban children's hospital from 1990 to 1995. Methods: We evaluated historical, clinical, and radiographic variables. Variables documented in 75% or more of the medical records and associated with intussusception (P less than or equal to.20) in the univariate analysis were evaluated in a multiple logistic regression analysis. Variables retaining significance (P less than or equal to.05) in the multivariate analysis were considered independent predictors of intussusception. We used bootstrap resampling techniques to validate the multivariate model. Results: Sixty-eight (59%) of the 115 patients had intussusception. Univariate predictors of intussusception included male sea, age younger than 2 years, history of emesis, rectal bleeding, lethargy, abdominal mass, and a highly suggestive abdominal radiograph. In the multivariate analysis, we identified only 4 independent predictors (adjusted odds ratio; 95% confidence interval): a highly suggestive abdominal radiograph (18.3; 4.0-83.1), rectal bleeding (17.3; 2.9-104.0), male sex (6.2; 1.2-32.3), and a history of emesis (13.4; 1.4-126.0). We identified 3 of these 4 variables (all but emesis) as independent predictors in more than 50% of 1000 bootstrap data samples. Conclusions: Rectal bleeding, a highly suggestive abdominal radiograph, and male sea are variables independently associated with intussusception in a cohort of children suspected of having this diagnosis. Knowledge of these variables may assist in clinical decision making regarding diagnostic and therapeutic interventions.