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Clinical application of ultrasonography in the diagnosis of intussusception
D M Bhisitkul1, R Listernick, A Shkolnik
1Division of General Academic and Emergency Pediatrics, Children's Memorial Hospital, Chicago, Illinois 60614.
Insights
Ultrasound is a highly sensitive and specific tool for diagnosing intussusception in children. Low-risk children benefit most from initial ultrasound, while high-risk cases warrant immediate barium enema.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Gastroenterology
Background:
- Intussusception is a common surgical emergency in infants and children.
- Accurate and timely diagnosis is crucial for favorable outcomes.
- Conventional diagnostic methods like barium enema can be invasive.
Purpose of the Study:
- To evaluate the diagnostic accuracy of ultrasound for intussusception in a pediatric emergency setting.
- To compare ultrasound with barium enema in diagnosing intussusception.
- To determine optimal diagnostic pathways based on clinical risk stratification.
Main Methods:
- Prospective study of 65 pediatric patients with suspected intussusception.
- Abdominal ultrasound performed prior to barium enema.
- Patients stratified into high-risk and low-risk groups based on clinical symptoms.
Main Results:
- Ultrasound demonstrated 100% sensitivity and 93% specificity for intussusception.
- Negative predictive value of ultrasound was 100%.
- A combined strategy of ultrasound for low-risk and barium enema for high-risk patients could reduce examinations by 89%.
Conclusions:
- Ultrasound is a rapid, sensitive, and specific screening tool for childhood intussusception.
- Initial ultrasound is recommended for low-risk children; immediate barium enema for high-risk cases.
- This approach optimizes diagnostic efficiency and patient management.
Abstract:
Sixty-five consecutive patients seen in a pediatric emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before a barium enema. The mean age of the patients was 1.7 years (range 2 weeks to 5 years). Intussusception was detected by ultrasonography in all 20 cases proved by barium enema. There were three false-positive ultrasound results (sensitivity = 100%, confidence interval (Cl) = 86% to 100%; specificity = 93%, Cl = 86% to 96%). Normal findings on ultrasonography correlated with a negative barium enema results in 42 of 42 cases (negative predictive value = 100%, Cl = 94% to 100%). No intussusception was missed by ultrasonography. To determine which patients would most benefit from ultrasonography, we divided patients into either a high-risk group (81% with intussusception) or a low-risk group (14% with intussusception) on the basis of clinical symptoms (p less than 0.01). If each high-risk child had a barium enema and each low-risk child had an ultrasound study as their initial diagnostic test, 89% of the patients in this study would have undergone only one examination. We conclude that ultrasonography can be used as a rapid, sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Children considered at low risk of having intussusception on the basis of clinical symptoms should initially have an ultrasound examination; patients at high risk should have an immediate barium enema.