Ultrasound-Based Prediction Model for Air Enema Failure in Pediatric Ileocolic Intussusception

Objectives: Pediatric ileocolic intussusception often presents without classic symptoms, making early diagnosis and management challenging. While the enema reduction is the standard treatment, failed reduction may lead to surgical intervention. This study aimed to identify predictors of reduction failure focusing on ultrasonographic features, to develop a predictive model and to assess capabilities of point-of-care ultrasound (POCUS). Methods: We conducted a retrospective study at a pediatric emergency center from January 2020 to December 2024. Children who underwent air enema reduction for ileocolic intussusception were included. Univariable and multivariable logistic regression analyses were performed to identify predictors of reduction failure. A prediction model was constructed using ultrasound features and validated using a distinct cohort. Paired comparative analysis between POCUS and radiologist-performed ultrasound was performed. Results: Among 179 children, 35 experienced failure. Most of the demographic and symptom-based variables were not significantly associated with outcomes. Radiologist-performed US revealed that lymph nodes around the lesion, greater invagination length, hypoechoic ring thickness, and suspected low vascularity were associated with failure. A multivariable logistic regression model using 6 ultrasound features demonstrated good predictive performance. External validation with 58 patients yielded good predictive performance and 100% sensitivity. Comparative analysis showed that radiologists more frequently assessed long-axis views and vascularity, identifying risk features more comprehensively than pediatric emergency physicians. Conclusions: Ultrasound-based features are possibly more reliable predictors of enema reduction failure in pediatric emergency settings. Our validated model and comparative analysis highlight the importance of standardized ultrasound assessment and support the expanded role of POCUS.