Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception: A...

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging Accuracy
• Gastrointestinal Disorders

Background:

• Intussusception is the leading cause of small bowel obstruction in children.
• Early and precise diagnosis is crucial to prevent bowel ischemia.
• This study evaluates diagnostic test accuracy for intussusception.

Purpose of the Study:

• To quantify the diagnostic test accuracy of history, physical examination, abdominal radiographs, and point-of-care ultrasound for pediatric intussusception.

Main Methods:

• Systematic review of diagnostic test accuracy studies published up to June 2019.
• Inclusion criteria: patients <18 years with abdominal complaints suggestive of intussusception.
• Data analysis using random effects models; bias assessed with QUADAS-2.

Main Results:

• History and physical exam showed low diagnostic accuracy (LR+ 1-2, LR- 0.4-0.8).
• Abdominal radiographs had low accuracy (LR+ 2.5, LR- 0.20, DOR 13).
• Point-of-care ultrasound demonstrated high accuracy (LR+ 19.7, LR- 0.10, DOR 213).

Conclusions:

• History and physical examination are not highly accurate for diagnosing intussusception.
• Abdominal radiographs offer limited diagnostic value for intussusception.
• Point-of-care ultrasound is the most accurate diagnostic tool for intussusception in children.