Work

Prediction of complications from pediatric multiple magnet ingestion: development and validation of radiologic and clinical-radiologic nomograms in a large retrospective study

Year: 2025

Type: article

Abstract: BACKGROUND: Current clinical models for pediatric multiple magnet ingestion lack accuracy in asymptomatic patients and in cases with unreliable histories, while radiologic predictors remain unvalidated. This study aimed to develop and validate two nomograms integrating radiologic (± clinical) features for individualized risk stratification. METHOD: This retrospective study analyzed data from 146 pediatric patients treated at Shenzhen Children's Hospital between 2017 and 2023. Risk factors were identified using the least absolute shrinkage and selection operator (LASSO) and multivariable logistic regression. Model performance was assessed using multiple metrics, with internal validation using 1000 bootstrap resamples. RESULTS: Complications occurred in 57 patients (39.0%; 65.1% male; median age, 4.6 years). Nomogram R (area under the receiver operating characteristic curve [AUC]: 0.85, 95% confidence interval [CI] 0.79-0.92; internally validated AUC: 0.86) included magnets size > 25 mm, blurred magnet edges, gap between magnets, and lack of progression on serial radiographs. Nomogram C&R (AUC: 0.95, 0.92-0.99; internally validated AUC: 0.96) incorporated multiple ingestions, vomiting, abdominal pain, magnets size > 25 mm, and lack of progression on serial radiographs. Both models demonstrated good fit (Hosmer-Lemeshow test), good calibration in calibration plots, and high clinical utility. Nomogram C&R demonstrated superior net reclassification improvement and integrated discrimination improvement. Sensitivity, specificity, and accuracy were 82.5%, 70.8%, and 75.3% for Nomogram R, and 87.7%, 92.1%, and 90.4% for Nomogram C&R. Web-based tools were created for clinical use. CONCLUSION: Nomogram C&R enables accurate complication risk stratification and supports personalised clinical decision-making in pediatric multiple magnet ingestion. Future prospective validation and integration into clinical pathways are warranted to further establish its role in routine practice.

Source: BMC Pediatrics

DOI: 10.1186/s12887-025-06302-3