Title: Transient and Persistent Small-Bowel Intussusception in Children: A Diagnostic Tree
Analysis Model Based on Ultrasound and Clinical Findings
Version: 9 Date: 19 Mar 2025
Reviewer's report:
In general:
1. The text should be reviewed by a native English speaker.
2. References in the text give ‘Error’.
In the Introduction:
1. What do authors mean by ‘failure’ at the sentence “…and other findings as independent
predictors of surgical intervention or failure have been documented in previous studies8,21.”?
Failure of spontaneous resolution?
2. Can the authors report a detailed list of USG features that are predictors of surgical
intervention according to previous studies?
In Materials and Methods:
1. Please clearly define the cases who “If the SBI was partially released without signs of
ischemia, the US was repeated at an interval of 45 min until it was released completely.” Such as
adding “If SBI resolved spontaneously, the diagnosis was defined as TSBI.” After this sentence.
2. How did the authors decide the cut-off point as 3.8 cm? which method used for calculating
cut-off value?
In the Results:
1. In general: PSBI total 61 cases = PLP: 46 cases + length >3.8 cm: 11 cases (18.4% of 61
cases) + 4 cases of no indication or defined PLP at operation??? (6.5%) (not at diagnosis time)
In training group: PSBI total 42 cases = PLP (USG): 31 cases + length >3.8 cm: 9 cases + 2
cases defined PLP at operation (?) (not at diagnosis time)
Also, within TSBI patients 31.4% has intussusception length >3.8 cm (with application of DTA
can be misdiagnosed as PSBI)
How DTA with PLP and length >3.8 cm: sensitivity=98.2%; specifity=100% and
accuracy=98.6% reveal? I believe that the calculations should be made from beginning.
2. I advise to give the same parameter to decrease confusion such as: “Furthermore, 5.4% of
patients with TSBI had an intussusceptum length of #3.8 cm, whereas 18.4% of patients with
PSBI had an intussusceptum length of #3.8 cm (P < 0.001)”
3. In the sentence “…and a total of eight kinds were found to have PLP (Table 2)” there is an
error in expression. I recommend “… and there were eight pathologies leading to PLP (Table 2).”
4. Was surgery decided directly in patients with PLP detected by US? Please mention.
5. Please explain DTA model in the text also.
In the Discussion:
1. Have other factors been investigated in the literature? In the discussion, can you elaborate
further on the factors used in the literature to distinguish between temporary and permanent
intussusception (even for ileocolic intussusceptions)?
2. For me the sentence “…and multiple small sacs were discovered within the nodules via US.”
Is unclear. Please detail what you mean.
3. What is the meaning of ‘placeholder’ in the sentence “Doppler US should be used to diagnose
the placeholder.”? Could the authors have used another word to be more descriptive?
4. If the head-of-intussusceptum thickness had the highest diagnostic efficiency, why did it not
used in DTA?
5. What do the authors mean by “Incomplete clinical information was difficult to obtain because
of the children’s manifestations29”?
6. The study is about differentiating PSBI and TSBI; So please stop discussing PLP and discuss
the factors that indicate failure of spontaneous resolution.
Title: Transient and Persistent Small-Bowel Intussusception in Children: A Diagnostic Tree
Analysis Model Based on Ultrasound and Clinical Findings
Version: 9 Date: 19 Mar 2025
Reviewer's report:
In general:
1. The text should be reviewed by a native English speaker.
2. References in the text give ‘Error’.
In the Introduction:
1. What do authors mean by ‘failure’ at the sentence “…and other findings as independent
predictors of surgical intervention or failure have been documented in previous studies8,21.”?
Failure of spontaneous resolution?
2. Can the authors report a detailed list of USG features that are predictors of surgical
intervention according to previous studies?
In Materials and Methods:
1. Please clearly define the cases who “If the SBI was partially released without signs of
ischemia, the US was repeated at an interval of 45 min until it was released completely.” Such as
adding “If SBI resolved spontaneously, the diagnosis was defined as TSBI.” After this sentence.
2. How did the authors decide the cut-off point as 3.8 cm? which method used for calculating
cut-off value?
In the Results:
1. In general: PSBI total 61 cases = PLP: 46 cases + length >3.8 cm: 11 cases (18.4% of 61
cases) + 4 cases of no indication or defined PLP at operation??? (6.5%) (not at diagnosis time)
In training group: PSBI total 42 cases = PLP (USG): 31 cases + length >3.8 cm: 9 cases + 2
cases defined PLP at operation (?) (not at diagnosis time)
Also, within TSBI patients 31.4% has intussusception length >3.8 cm (with application of DTA
can be misdiagnosed as PSBI)
How DTA with PLP and length >3.8 cm: sensitivity=98.2%; specifity=100% and
accuracy=98.6% reveal? I believe that the calculations should be made from beginning.
2. I advise to give the same parameter to decrease confusion such as: “Furthermore, 5.4% of
patients with TSBI had an intussusceptum length of #3.8 cm, whereas 18.4% of patients with
PSBI had an intussusceptum length of #3.8 cm (P < 0.001)”
3. In the sentence “…and a total of eight kinds were found to have PLP (Table 2)” there is an
error in expression. I recommend “… and there were eight pathologies leading to PLP (Table 2).”
4. Was surgery decided directly in patients with PLP detected by US? Please mention.
5. Please explain DTA model in the text also.
In the Discussion:
1. Have other factors been investigated in the literature? In the discussion, can you elaborate
further on the factors used in the literature to distinguish between temporary and permanent
intussusception (even for ileocolic intussusceptions)?
2. For me the sentence “…and multiple small sacs were discovered within the nodules via US.”
Is unclear. Please detail what you mean.
3. What is the meaning of ‘placeholder’ in the sentence “Doppler US should be used to diagnose
the placeholder.”? Could the authors have used another word to be more descriptive?
4. If the head-of-intussusceptum thickness had the highest diagnostic efficiency, why did it not
used in DTA?
5. What do the authors mean by “Incomplete clinical information was difficult to obtain because
of the children’s manifestations29”?
6. The study is about differentiating PSBI and TSBI; So please stop discussing PLP and discuss
the factors that indicate failure of spontaneous resolution.
Please review this paper.
user
Title: Transient and Persistent Small-Bowel Intussusception in Children: A Diagnostic Tree
Analysis Model Based on Ultrasound and Clinical Findings
Version: 9 Date: 19 Mar 2025
Reviewer's report:
In general:
1. The text should be reviewed by a native English speaker.
2. References in the text give ‘Error’.
In the Introduction:
1. What do authors mean by ‘failure’ at the sentence “…and other findings as independent
predictors of surgical intervention or failure have been documented in previous studies8,21.”?
Failure of spontaneous resolution?
2. Can the authors report a detailed list of USG features that are predictors of surgical
intervention according to previous studies?
In Materials and Methods:
1. Please clearly define the cases who “If the SBI was partially released without signs of
ischemia, the US was repeated at an interval of 45 min until it was released completely.” Such as
adding “If SBI resolved spontaneously, the diagnosis was defined as TSBI.” After this sentence.
2. How did the authors decide the cut-off point as 3.8 cm? which method used for calculating
cut-off value?
In the Results:
1. In general: PSBI total 61 cases = PLP: 46 cases + length >3.8 cm: 11 cases (18.4% of 61
cases) + 4 cases of no indication or defined PLP at operation??? (6.5%) (not at diagnosis time)
In training group: PSBI total 42 cases = PLP (USG): 31 cases + length >3.8 cm: 9 cases + 2
cases defined PLP at operation (?) (not at diagnosis time)
Also, within TSBI patients 31.4% has intussusception length >3.8 cm (with application of DTA
can be misdiagnosed as PSBI)
How DTA with PLP and length >3.8 cm: sensitivity=98.2%; specifity=100% and
accuracy=98.6% reveal? I believe that the calculations should be made from beginning.
2. I advise to give the same parameter to decrease confusion such as: “Furthermore, 5.4% of
patients with TSBI had an intussusceptum length of #3.8 cm, whereas 18.4% of patients with
PSBI had an intussusceptum length of #3.8 cm (P < 0.001)”
3. In the sentence “…and a total of eight kinds were found to have PLP (Table 2)” there is an
error in expression. I recommend “… and there were eight pathologies leading to PLP (Table 2).”
4. Was surgery decided directly in patients with PLP detected by US? Please mention.
5. Please explain DTA model in the text also.
In the Discussion:
1. Have other factors been investigated in the literature? In the discussion, can you elaborate
further on the factors used in the literature to distinguish between temporary and permanent
intussusception (even for ileocolic intussusceptions)?
2. For me the sentence “…and multiple small sacs were discovered within the nodules via US.”
Is unclear. Please detail what you mean.
3. What is the meaning of ‘placeholder’ in the sentence “Doppler US should be used to diagnose
the placeholder.”? Could the authors have used another word to be more descriptive?
4. If the head-of-intussusceptum thickness had the highest diagnostic efficiency, why did it not
used in DTA?
5. What do the authors mean by “Incomplete clinical information was difficult to obtain because
of the children’s manifestations29”?
6. The study is about differentiating PSBI and TSBI; So please stop discussing PLP and discuss
the factors that indicate failure of spontaneous resolution.
assistant