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Vomiting, Pyloric Mass, and Point-of-Care Ultrasound: Diagnostic Test Accuracy for Hypertrophic Pyloric Stenosis-A
Jeffrey Hom1, Samuel H F Lam2, Kristen M Delaney3
1Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York; Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
Insights
Point-of-care ultrasound (POCUS) and palpating a pyloric mass are highly accurate for diagnosing hypertrophic pyloric stenosis in infants. Vomiting is a less reliable indicator, showing lower diagnostic test measures.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Infant Health
Background:
- Hypertrophic pyloric stenosis (HPS) is a frequent cause of nonbilious vomiting in infants under six months.
- The diagnostic accuracy of history, physical examination, and point-of-care ultrasound (POCUS) for HPS has not been previously compared.
Purpose of the Study:
- To systematically review and compare the diagnostic test accuracy of POCUS, palpation of a pyloric mass, and infant history of vomiting for HPS.
Main Methods:
- A systematic literature search was conducted from 1977 to March 2022.
- Diagnostic accuracy of POCUS, palpation, and vomiting were evaluated using bivariate analysis.
- Bias was assessed using the QUADAS-2 tool.
Main Results:
- POCUS demonstrated high sensitivity (97.7%) and specificity (94.1%) for HPS detection.
- Palpation of a pyloric mass showed a sensitivity of 73.5% and high specificity (97.5%).
- Vomiting had a sensitivity of 91.3% but lower specificity (60.8%). Both POCUS and palpation had high positive likelihood ratios (LR+).
Conclusions:
- POCUS and palpation of a pyloric mass are highly specific and reliable diagnostic methods for HPS.
- Vomiting alone is a less accurate diagnostic indicator for HPS compared to POCUS and palpation.
Background:
Hypertrophic pyloric stenosis is a common cause of nonbilious vomiting in infants younger than 6 months. Its history, physical examination, and point-of-care ultrasound (POCUS) have not been compared for their diagnostic test accuracy.
Objective:
The aim of this systematic review was to quantify and compare the diagnostic test accuracy of a history of vomiting, a pyloric mass on palpation, and POCUS.
Methods:
We performed three searches of the literature from 1977 to March 2022. We evaluated bias using the QUADAS-2 (Quality Assessment Tool for Diagnostic Accuracy-2) tool. We performed a bivariate analysis.
Results:
From 5369 citations, we identified 14 studies meeting our inclusion criteria. We quantified three diagnostic elements: POCUS, a pyloric mass on palpation, and vomiting. We identified five studies that analyzed POCUS, which included 329 patients. POCUS had a sensitivity of 97.7% (95% confidence interval (CI) 93.1-99.3%) and a specificity of 94.1% (95% CI 88.7-97.1%) for detecting pyloric stenosis. We identified six studies that analyzed the presence of a pyloric mass, which included 628 patients. The palpation of a pyloric mass had a sensitivity of 73.5% (95% CI 62.6-82.1%) and a specificity of 97.5% (95% CI 93.8-99.0%). We identified four studies that analyzed vomiting, which included 355 patients. Vomiting had a sensitivity of 91.3% (95% CI 82.1-96.0) and a specificity of 60.8% (95% CI 8.5-96.3). Both POCUS and palpation of a pyloric mass had a high positive likelihood ratio (LR+: 17 and 33, respectively). The LR+ for vomiting was 5.0.
Conclusions:
Both POCUS and palpable mass had high specificity and positive LR, whereas vomiting provided the lowest diagnostic test measures.
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