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Diagnostic Accuracy of Point-Of-Care Ultrasound for Intussusception Performed by Pediatric Emergency Medicine
Alexander C Arroyo1, Jessica Zerzan1, Hector Vazquez1
1Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
Insights
Point-of-care ultrasound (POCUS) by trained pediatric emergency physicians accurately diagnoses intussusception (INT) in children. This rapid emergency department tool shows high agreement with radiology-performed studies, improving diagnostic speed and accuracy.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Technology
Background:
- Intussusception (INT) is a leading cause of bowel obstruction in pediatric patients.
- Delayed diagnosis of INT can result in severe complications and increased mortality.
- Point-of-care ultrasound (POCUS) is being evaluated for early INT diagnosis by non-radiologists.
Purpose of the Study:
- To assess the diagnostic accuracy of POCUS for INT in children.
- To evaluate the performance of novice sonographer pediatric emergency medicine physicians (PEM-Ps) after focused ultrasound training.
- To compare POCUS findings with radiology-performed ultrasound (RPUS) for INT diagnosis.
Main Methods:
- Prospective observational study involving 17 trained PEM-Ps (14 attendings, 3 fellows).
- PEM-Ps performed and interpreted POCUS on children with suspected INT.
- POCUS results were compared with a subsequent RPUS interpreted by a pediatric radiologist.
Main Results:
- Excellent diagnostic agreement (97%; κ = 0.826) between PEM-P POCUS and RPUS for INT presence/absence.
- POCUS demonstrated high sensitivity (89%) and specificity (98%) for INT diagnosis.
- Positive POCUS had a likelihood ratio of 40.44, and negative POCUS had a likelihood ratio of 0.11.
Conclusions:
- POCUS performed by novice PEM-Ps shows high diagnostic concordance with RPUS for INT.
- Emergency department-based POCUS is a rapid and accurate method for diagnosing intussusception.
- This approach can expedite diagnosis and management of INT in pediatric patients.
Background:
Intussusception (INT) is a common cause of bowel obstruction in young children. Delay in diagnosis can lead to significant morbidity and mortality. There have been several studies evaluating early point-of-care ultrasound (POCUS) in the diagnosis of INT by nonradiologists.
Objective:
Our objective was to determine the diagnostic accuracy of POCUS by novice sonographer pediatric emergency medicine physicians (PEM-Ps) who received focused US training for diagnosing INT.
Methods:
We performed a prospective observational study including 17 PEM-Ps (14 attendings, 3 fellows) trained to perform abdominal US for INT. Children suspected of having INT received POCUS performed and interpreted by a PEM-P, followed by a US study performed by a certified ultrasonographer and interpreted by an attending pediatric radiologist. Diagnostic concordance between PEM-P-and radiology-performed US (RPUS) results was assessed.
Results:
One hundred patients were enrolled; median patient age was 24 months. There was excellent diagnostic agreement for presence or absence of INT between PEM-Ps and RPUS (97% of cases; κ = 0.826). POCUS-diagnosed INT was present in 8 of 9 patients with RPUS-diagnosed INT (sensitivity 89%; 95% confidence interval [CI] 51-99%; specificity 98%; 95% CI 92-100%; positive predictive value 80%; 95% CI 44-96%; negative predictive value 99%; 95% CI 93-100%). Likelihood ratio for INT with a positive POCUS was 40.44 (95% CI 10.07-162.36) and with a negative POCUS was 0.11 (95% CI 0.02-0.72).
Conclusions:
POCUS performed by novice sonographers to diagnose INT has high diagnostic concordance with RPUS. Emergency department-performed POCUS is a rapid and accurate method for diagnosing INT.
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