Cost-effective imaging approach to the nonbilious vomiting infant

Area of Science:

• Pediatric Imaging
• Gastroenterology
• Surgical Diagnostics

Background:

• Infant emesis is a common referral reason to pediatric imaging centers.
• Differentiating hypertrophic pyloric stenosis (HPS) from other causes requires accurate and timely diagnosis.
• Existing diagnostic pathways may involve multiple imaging studies, increasing costs and time.

Purpose of the Study:

• To develop a cost- and time-effective algorithm for differentiating HPS in infants with emesis.
• To reduce the need for multiple imaging modalities in diagnosing the cause of vomiting.
• To improve the efficiency of diagnostic workups in a tertiary care setting.

Main Methods:

• A volumetric assessment of gastric aspirate was used to guide imaging choices.
• Infants with >/=5 mL aspirate underwent ultrasonography (US) for HPS; <5 mL suggested medical causes, proceeding to upper gastrointestinal series (UGI).
• Surgeons performed abdominal palpation in a subset of patients.

Main Results:

• The volumetric criteria achieved 91% sensitivity and 88% specificity for HPS.
• Only 7% of infants required both US and UGI, significantly reducing the number of studies performed.
• The volumetric method resulted in savings of $4464 and 30 physician hours.

Conclusions:

• The volumetric method is a cost- and time-effective tool for evaluating nonbilious vomiting in infants for pyloric stenosis.
• Implementing this algorithm reduces the number of imaging studies needed, improving diagnostic efficiency.
• Optimizing fasting periods (3-4 hours) further enhances the volumetric method's accuracy to 96%.