Dear Dr. Temesgen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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ACADEMIC EDITOR:

The manuscript addresses the management outcomes of pediatric intussusception in a tertiary care hospital and includes a sizeable cohort of 257 patients. The study addresses an important and clinically meaningful issue, especially in relation to delayed presentation and preventable mortality in pediatric intussusception. The topic is clinically relevant, particularly from a global public health perspective. However, the manuscript would benefit from a clearer statement of its specific contribution to the existing literature. The authors should revise the hypothesis and objective to emphasize what this study adds beyond existing evidence, such as local management outcomes, predictors of prolonged hospital stay, or implications for earlier referral and access to care.

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We look forward to receiving your revised manuscript.

Kind regards,

Ozlem Boybeyi

Academic Editor

PLOS One

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Additional Editor Comments:

The manuscript addresses the management outcomes of pediatric intussusception in a tertiary care hospital and includes a sizeable cohort of 257 patients. The study addresses an important and clinically meaningful issue, especially in relation to delayed presentation and preventable mortality in pediatric intussusception. The topic is clinically relevant, particularly from a global public health perspective. However, the manuscript would benefit from a clearer statement of its specific contribution to the existing literature. The authors should revise the hypothesis and objective to emphasize what this study adds beyond existing evidence, such as local management outcomes, predictors of prolonged hospital stay, or implications for earlier referral and access to care.

Besides this and the recommendations of the reviewers, the following issues should also be revised:

The abstract should provide the corresponding statistical values, particularly p values and/or confidence intervals, for these associations. Without these data, it is difficult for readers to assess the strength and reliability of the reported findings.

The Introduction is somewhat lengthy and could be streamlined. The authors should consider shortening background information that is already well established and focus more directly on the rationale for this specific study, the knowledge gap, and the public health relevance of delayed presentation and preventable mortality.

Figure 1 appears blurred and should be replaced with a higher-resolution version to improve readability.

Figure 3 may be omitted or revised to improve clarity.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: No

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Reviewer #1: 1. Introduction is too long and the aim of the study has not been clearly described. There is too much additional information, that makes hard to focus on the topic.

2. Methods section is also too long and involves too much additional information, that can be discussed in another section.

3. protocol of the study is not evidence based.

for example:

how did they perform 3 consecutive attempts

definition of successful hydrostatic reduction

indication for hydrostatic reduction

NPO to minimize the risk of early recurrence (2 hours after successful HR is recommended in latest literature)

4. Although the authors mentioned the lack of recurrence data as a limitation, however recurrence is an important outcome if the researchers want to analyze the success ratio of hydrostatic reduction.

5. Although there have been detailed statistical analysis of data, discussion section is not adequate and superficial.

Reviewer #2: This is an important study that assesses factors associated with hospital stay and outcome of intussusception patients in Northern region in Ethiopia. It highlights the importance of non-invasive methods such as hydrostatic reduction in patient management and emphasizes key gaps and recommendations to improve timely care.

Overall, the manuscript is good and addresses a relevant topic. However, it needs some revision and a thorough grammar review to improve academic rigor. Particularity, the correct use of tense, and use of casual words such as “besides” and repeated use of “also” is not fit for academic writing and should be corrected/replaced accordingly. Please find below my specific comments and suggestions.

Please include location (Ethiopia/ Northern- Western Ethiopia) in the title and abstract

Methods

The information in line 114 regarding the population served by the hospital is repeated in lines 126–127. Consider removing the earlier statement, as the latter provides more specific information. Additionally, it would be helpful to clarify whether this is the only comprehensive hospital serving the region or if there are other comparable hospitals, as this would provide important context.

Are there any articles/references to support the statement on how laparotomy was associated with longer stay and higher morbidity at the center? If it was meant in more a general sense also needs to be rephrased and appropriate references included.

Use of abbreviations such as ICU, OR etc. first must be spelled in full description at the first mention with the abbreviations in parentheses, then the abbreviated form can be used for the remainder.

Include a sample size or justification. The use of consecutive sampling is appropriate for this study design; however, providing an estimated sample size based on the number of patients seeking care at the study site would strengthen the statistical validity of the study

Information on factors affecting decision on mode of treatment (Open Vs Hydrostatic reduction) in study population section is duplication as it is mentioned in intervention modality section, would remove.

Result

The last paragraph in the demographics sub-section describes treatment modality and outcome of patients so it should be included in the second sub-section on management and outcome.

Fig. 2. Flow diagram, on the left side where open surgery numbers are reported, instead of total managed by open surgery it written as total managed by hydrostatic reduction, needs to be corrected.

Fig.3. Are the numbers percentages? If so, it needs to be written with % or mentioned in the description. Additionally in the graph it says 82% no complication while 83.5 % is used in the result section. Findings should be consistent and as well as the use of decimals throughout the manuscript.

Remove “it” from sub-section title page 278

Table 2 is confusing and seems like two separate tables merged, needs to be clearer and adjusted.

It would be great to have a table that summarizes findings with hydrostatic reduction vs open surgery of the different variables assessed (days before arrival/duration of symptoms, length of stay, status on arrival (temperature, hydration etc.).

Discussion

Discussion is good and highlights critical findings in the study. However, there is repetition of points and needs to be more concise and grammatically edited. Particularly the paragraph starting from line 333 and line 380, are both discussing points related to delayed presentation, better to merge and highlight the main points.

Conclusion and Recommendations

It’s great you included points on how findings relate to broader low resource setting and SDGs, but you first need to highlight the implications of findings and specific recommendations for Ethiopian context.

When drafting the recommendations, please avoid using directive language such as "shall be." Instead, frame the recommendations as suggestions based on the study findings, for example, "Based on the findings, the study team recommends…". You have highlighted several important gaps for future research.

Additionally, I recommend emphasizing the need for qualitative studies exploring caregivers' experiences which would provide a deeper understanding of the factors contributing to delayed presentation and help inform context-specific interventions to improve timely care.

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Reviewer #1: No

Reviewer #2: No

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Management Outcomes and Factors Related to Hospital Stay for Pediatric Intussusception in a Tertiary Care Hospital, Northwestern Ethiopia

PONE-D-26-16101R1

Dear Dr. Temesgen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Ozlem Boybeyi

Academic Editor

PLOS One

Additional Editor Comments (optional):

The authors have comprehensively revised the manuscript and have addressed both the knowledge gap and the public health relevance. The revisions to the main text and tables are also appropriate and sufficient, and they have improved the clarity and academic quality of the manuscript.

Given that the study addresses an important and clinically meaningful issue, particularly from a global public health perspective, I recommend the manuscript for publication in its current form.

However, in accordance with the journal’s authorship policy, it is recommended that the authors confirm that approval has been obtained from all authors regarding the change in authorship.

Reviewers' comments: