Effectiveness of ultrasound-guided hydrostatic versus fluoroscopy-guided air reduction for pediatric intussusception: a severity-adjusted cohort analysis.
After adjusting for severity, reduction technique was not linked to failure risk
Effectiveness of ultrasound-guided hydrostatic versus fluoroscopy-guided air reduction for pediatric intussusception: a severity-adjusted cohort analysis.
The comparative effectiveness of fluoroscopy-guided air reduction (fluoroscopy-guided air reduction) versus ultrasound-guided hydrostatic reduction (ultrasound-guided hydrostatic reduction) for pediatric intussusception remains uncertain, especially when clinical and sonographic severity are considered.
To compare the effectiveness and safety of fluoroscopy-guided air reduction and ultrasound-guided hydrostatic reduction after adjusting for disease severity and to identify independent predictors of non-operative reduction failure.
A retrospective cohort of 192 children (0-24 months) with ileocolic intussusception treated between 2018 and 2024 was analyzed.
reduction technique made no difference to failure odds once severity was accounted for
Initial success was 86.3% for fluoroscopy-guided air reduction and 77.7% for ultrasound-guided hydrostatic reduction (p = 0.12); however, the ultrasound-guided hydrostatic reduction group had significantly more trapped fluid and longer symptom duration at baseline.
Independent predictors included longer symptom duration (aOR 1.27 per 12 h; p < 0.001), anal protruding mass (aOR 3.58; p = 0.01), greater intussusceptum length (aOR 1.41 per cm; p < 0.001), and trapped fluid (aOR 3.47; p < 0.001).
Model discrimination was excellent (AUC 0.85).
After adjusting for disease severity, ultrasound-guided hydrostatic reduction and fluoroscopy-guided air reduction show equivalent effectiveness and safety.
Crude differences reflect more severe presentations in the ultrasound-guided hydrostatic reduction group.
Severity markers-including symptom duration, trapped fluid, and intussusceptum length-are strong predictors of failure and should guide clinical decision-making.