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The abdominal radiographic series in children with suspected bowel obstruction--should the second view be abandoned?
Ursula M Hughes1, Karen E Thomas, Bruce Shuckett
1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada. hughes_u@yahoo.com
Insights
Adding a second radiograph view to supine abdominal X-rays offers limited improvement in diagnosing paediatric bowel obstruction. This second view should be reserved for cases with persistent diagnostic uncertainty.
Area of Science:
- Radiology
- Pediatric Imaging
- Gastrointestinal Disorders
Background:
- Paediatric bowel obstruction is a common surgical emergency.
- Accurate diagnosis relies heavily on radiographic interpretation.
Purpose of the Study:
- To evaluate the diagnostic accuracy improvement of adding a second radiograph view to supine abdominal X-rays for paediatric bowel obstruction.
- To assess the impact of an additional horizontal beam view on diagnostic performance.
Main Methods:
- Retrospective review of 72 paediatric patient abdominal radiographs.
- Evaluation by 22 independent observers (radiologists, surgeons, emergency physicians).
- Comparison of diagnostic accuracy using supine view alone versus supine plus a second view (upright or decubitus).
Main Results:
- Supine view alone: sensitivity 66%, specificity 72%, accuracy 70%.
- With a second view: sensitivity 78%, specificity 75%, accuracy 76%.
- Mean accuracy increase of 6% with no significant difference across observer groups.
Conclusions:
- The routine addition of a second radiograph view provides limited diagnostic accuracy improvement for paediatric bowel obstruction.
- Consideration of a second view should be limited to selected cases with persistent diagnostic uncertainty.
Objective:
To determine whether the addition of a second (horizontal beam) view to the supine abdominal radiograph improves diagnostic accuracy in the diagnosis of paediatric bowel obstruction.
Materials And Methods:
The abdominal radiographs of 72 paediatric patients were retrospectively evaluated for the presence of bowel obstruction by 22 independent observers (radiologists, surgeons and emergency physicians) of varying experience. Evaluation involved initial assessment of the supine radiograph alone, followed by reassessment with the addition of an upright or decubitus radiograph.
Results:
When observers evaluated supine radiographs alone, their sensitivity was 66%, specificity 72% and accuracy 70%. With the addition of the second view sensitivity was 78%, specificity 75% and accuracy 76%. The mean change in accuracy was 6% with no statistically significant difference between radiologists, surgeons or emergency staff.
Conclusions:
The value of the routine second radiograph in the accuracy of diagnosis of bowel obstruction is limited, and its use should be restricted to selected cases in which diagnostic uncertainty persists.