Early recurrence after successful hydrostatic reduction of intussusception occurs in 5–15% of children and often requires repeat intervention, yet reliable predictors remain incompletely defined. To identify clinical and sonographic predictors of early recurrence (within 48 h) after ultrasound-guided hydrostatic reduction of ileocolic intussusception, and to develop a weighted nomogram and a simplified bedside score for risk stratification.

This retrospective study included 677 children who underwent successful ultrasound-guided hydrostatic reduction between January 2020 and December 2025. Early recurrence occurred in 66 patients (9.7%). Predictors were identified by LASSO regression and multivariable logistic analysis. A nomogram was constructed, and a simplified scoring system was derived for rapid bedside use. Recurrence timing was analyzed using Kaplan-Meier curves and Spearman's correlation.

Five independent predictors were identified: transverse colon location (OR 4.647), previous intussusception history (OR 2.831), target sign diameter > 35 mm (OR 1.075 per mm), peritoneal effusion (OR 2.476), and sonographic features of enteritis (OR 2.347). The nomogram showed good discrimination (AUC 0.805). The simplified score (0–5), assigning 1 point to each predictor, also demonstrated acceptable discrimination (AUC 0.795), with a cutoff of 3 points optimally balancing sensitivity (62.1%) and specificity (84.3%). Median recurrence time was 23 h; recurrences were evenly distributed across the 48-h window, and the five predictors did not influence the exact timing of recurrence.

A weighted nomogram and a simple bedside score based on five clinical and sonographic features accurately predict early recurrence after hydrostatic reduction of ileocolic intussusception. The tools enable individualized risk assessment and support risk-stratified observation strategies.