Pediatric Emergency Medicine Point-of-Care Ultrasound for the Diagnosis of Intussusception
Theodore E Trigylidas1, Mary A Hegenbarth1, Lina Patel1
1Department of Pediatrics, University of Missouri-Kansas City School of Medicine and Division of Emergency Medicine, Children's Mercy Hospital, Kansas City, Missouri.
Insights
Pediatric emergency medicine physician point-of-care ultrasound (POCUS) accurately diagnoses intussusception. Younger children or those with distal intussusception face higher risks of air enema failure.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Point-of-Care Ultrasound
Background:
- Delayed intussusception diagnosis increases morbidity and air enema failure rates.
- Limited data exists on the diagnostic accuracy of pediatric emergency medicine physician point-of-care ultrasound (POCUS) for intussusception.
Purpose of the Study:
- To assess the accuracy of POCUS performed by pediatric emergency medicine (PEM) physicians in diagnosing ileocolic intussusception.
- To identify factors contributing to air enema failure in pediatric intussusception cases.
Main Methods:
- Retrospective analysis of POCUS examinations for suspected intussusception in children (January 2001 - December 2015).
- Inclusion criteria required confirmation of POCUS interpretation by a pediatric radiologist via image review, radiology ultrasound, or air enema.
- Analysis of age, symptom duration, recurrent intussusception, and location as predictors of air enema failure.
Main Results:
- 102 POCUS exams were performed on 101 eligible patients; 75 had confirmed intussusception.
- PEM POCUS demonstrated high diagnostic accuracy: sensitivity 96.0%, specificity 92.6%, PPV 97.3%, NPV 89.3%.
- Air enema failure was significantly associated with intussusception distal to the splenic flexure (OR=10.00) and age <6 months (OR=6.83).
Conclusions:
- Pediatric emergency medicine POCUS is a highly sensitive and specific tool for diagnosing intussusception.
- Infants under 6 months and cases with intussusception distal to the splenic flexure are at increased risk for air enema failure.
Background:
Delayed diagnosis of intussusception can lead to air enema failure and increased morbidity. There are limited studies reporting the accuracy of pediatric emergency medicine (PEM) physician point-of-care ultrasound (POCUS) in diagnosing intussusception.
Objectives:
The primary objective was to evaluate the accuracy of PEM POCUS in identifying ileocolic intussusception. The secondary objective was to identify factors associated with air enema failure.
Methods:
This was a retrospective study of children who underwent POCUS for suspected intussusception in a pediatric emergency department between January 2001 and December 2015. Patients were included if a pediatric radiologist confirmed the POCUS examination interpretation by image review, radiology department ultrasound, or air enema. Age, symptom duration, recurrent intussusception, and location of intussusception were examined as factors for air enema failure.
Results:
One hundred and two POCUS examinations were completed on 101 patients who met the inclusion criteria. The mean age of patients was 22 months. Of 75 patients with intussusception, 72 were detected with POCUS. PEM POCUS had a sensitivity of 96.0% (95% confidence interval [CI] 91.6-100.0%), specificity of 92.6% (95% CI 82.7-100.0%), positive predictive value of 97.3% (95% CI 93.6-100.0%), and negative predictive value of 89.3% (95% CI 77.8-100.0%). Air enema failure was associated with intussusception distal to the splenic flexure (odds ratio = 10.00 [95% CI 2.81-35.61]; p < 0.01) and age <6 months (OR = 6.83 [95% CI 1.94-24.09]; p < 0.01).
Conclusion:
PEM POCUS identifies intussusception with high sensitivity and specificity. Patients <6 months old or with intussusception distal to the splenic flexure had a higher risk of air enema failure.
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