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Pediatric barium enema examination: optimizing patient selection with univariate and multivariate analyses
R Y Kanterman1, M J Siegel, J E Rossiter
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Identifying key clinical indicators can help select pediatric patients for barium enema examinations, reducing unnecessary procedures while minimizing missed diagnoses of conditions like intussusception and appendicitis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Barium enema examinations are frequently used in pediatric patients for diagnosing gastrointestinal conditions.
- Predicting the likelihood of an abnormal barium enema study is crucial for optimizing resource allocation and patient care.
Purpose of the Study:
- To identify clinical symptoms, signs, and laboratory findings that predict abnormal barium enema examinations in pediatric patients.
- To develop a strategy for selecting patients who would benefit most from barium enema studies.
Main Methods:
- Prospective evaluation of 19 symptoms, signs, and laboratory findings in 471 pediatric patients undergoing barium enema.
- Univariate analysis and logistic regression modeling to determine predictive indicators.
Main Results:
- Abnormal barium enema studies were found in 22% of patients, with common diagnoses including intussusception, appendicitis, infectious colitis, and Hirschsprung disease.
- Predictive indicators for abnormal studies included abdominal mass, leukocytosis, guaiac-positive stools, diarrhea, anemia, tenderness, and age under 1 year.
- Implementing a strategy based on these indicators could eliminate 29% of examinations while missing only 4.8% of diseases.
Conclusions:
- Specific clinical variables effectively predict barium enema abnormalities in pediatric patients.
- Utilizing these predictive indicators can guide the selection of patients for barium enema, improving diagnostic efficiency.
- This approach supports a more targeted use of barium enema examinations in pediatric care.
Abstract:
We prospectively evaluated a total of nineteen symptoms, signs, and laboratory findings in 471 of 557 consecutive pediatric patients (from newborn to age 17) referred for barium enema examinations, to determine predictors of an abnormal study. A univariate analysis was performed, and a logistic regression model was developed. The most frequent indicators for the barium enema examinations were abdominal pain (48%), constipation (27%) and tenderness (25%). Twenty-two percent of the examinations were abnormal, and the most common diagnoses were intussusception (n = 22), appendicitis (n = 17), infectious colitis (n = 15), and Hirschsprung disease (n = 14). The indicators that were most helpful to predict a barium enema abnormality were abdominal mass, leukocytosis, guaiac-positive stools, diarrhea, anemia, tenderness, and age less than 1 year. If barium enema examinations were performed only when at least one of the predictive indicators was present, 29% of examinations would be eliminated, and 4.8% of patients with detectable disease would be missed. The data indicate that identification of certain clinical variables can provide an effective initial strategy for selecting patients to undergo barium enema examinations.