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Accuracy of plain radiographs to exclude the diagnosis of intussusception

Cindy G Roskind1, Gunjan Kamdar, Carrie B Ruzal-Shapiro

  • 1Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, USA. Cg278@columbia.edu

Pediatric Emergency Care
|August 30, 2012
PubMed

Insights

The 3-view abdominal radiograph can help rule out ileocolic intussusception in children. Observing air in the ascending colon on these views can decrease the need for further diagnostic imaging when clinical suspicion is low.

Area of Science:

  • Pediatric Radiology
  • Gastrointestinal Imaging

Background:

  • Intussusception is a common surgical emergency in children.
  • Accurate and timely diagnosis is crucial for effective management.
  • Abdominal radiography is a readily available imaging modality.

Purpose of the Study:

  • To prospectively evaluate the diagnostic accuracy of a 3-view abdominal radiograph series.
  • To determine the test characteristics for diagnosing ileocolic intussusception.
  • To assess the utility of specific radiographic findings in excluding intussusception.

Main Methods:

  • Prospective cross-sectional study in a pediatric emergency department.
  • Inclusion of children aged 3 months to 3 years with suspected intussusception.
  • Acquisition of supine, prone, and left lateral decubitus abdominal radiographs.
  • Confirmation of intussusception status via air enema, ultrasound, operative report, or clinical follow-up.
  • Radiologist review of radiographs for visualized air in the ascending and transverse colons.

Main Results:

  • Out of 128 patients, 19 (14.8%) had intussusception.
  • Using air in the ascending colon on all 3 views yielded 100% sensitivity and 17.4% specificity.
  • This criterion also provided 100% negative predictive value, effectively excluding intussusception.
  • Presence of air in 2 or more views improved specificity to 45.0% but decreased sensitivity.
  • Air in the transverse colon showed moderate sensitivity (84.2%) and improved specificity (63.3%).

Conclusions:

  • The 3-view abdominal radiograph, particularly the presence of air in the ascending colon, can effectively decrease the likelihood of intussusception.
  • This radiographic finding may obviate the need for further diagnostic studies in low-suspicion cases.
  • Radiographic assessment can aid in excluding intussusception, guiding clinical decision-making.
Abstract

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