Related Experiment Video
Updated: Dec 8, 2025
Flexible Colonoscopy in Mice to Evaluate the Severity of Colitis and Colorectal Tumors Using a Validated Endoscopic Scoring System
Published on: October 16, 2013
Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception: A
Jeffrey Hom, Carl Kaplan, Susan Fowler1
1Washington University, Brown School Library, St. Louis, MO.
Insights
Point-of-care ultrasound offers the highest diagnostic accuracy for intussusception in children. This imaging technique is superior to history, physical exam, and abdominal radiographs for ruling intussusception in or out.
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.
Introduction:
Intussusception is the most common cause of pediatric small bowel obstruction. Timely and accurate diagnosis may reduce the risk of bowel ischemia. We quantified the diagnostic test accuracy of history, physical examination, abdominal radiographs, and point-of-care ultrasound.
Method:
We conducted a systematic review for diagnostic test accuracy of history, physical examination, and imaging concerning for intussusception. Our literature search was completed in June 2019. Databases included Medline via Ovid, Embase, Scopus, and Wiley Cochrane Library. We conducted a second review of the literature up to June 2019 for any additional studies. Inclusion criteria were younger than 18 years and presenting to the emergency department for abdominal complaints, consistent with intussusception. We performed data analysis using mada, version 0.5.8. We conducted univariate and bivariate analysis (random effects model) with DerSimonian-Laird and Reitsma model, respectively. QUADAS-2 was used for bias assessment.
Results:
The literature search identified 2639 articles, of which 13 primary studies met our inclusion criteria. Abdominal pain, vomiting, and bloody stools had positive likelihood ratios LR(+) between 1 and 2, whereas the negative likelihood ratio, LR(-), ranged between 0.4 and 0.8. Abnormal abdominal radiograph had LR(+) of 2.5 and LR(-) of 0.20, whereas its diagnostic odds ratio was 13. Lastly, point-of-care ultrasound had LR(+) of 19.7 and LR(-) of 0.10. The diagnostic odds ratio was 213.
Conclusions:
History and physical examination had low diagnostic test accuracy. Abdominal radiographs had low diagnostic test accuracy, despite moderate discriminatory characteristics. Point-of-care ultrasound had the highest diagnostic test accuracy to rule in or rule out intussusception.
Related Concept Videos
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:25Assessment of the Abdomen I: Inspection and Auscultation
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection....
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...