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Plain abdominal radiography in suspected intussusception: a reassessment
M A Sargent1, P Babyn, D J Alton
1Department of Diagnostic Radiology, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatric Radiology
|January 1, 1994
Summary
Abdominal radiographs (AXR) show significant interobserver variation in diagnosing childhood intussusception. While AXR can be 84% accurate when a firm diagnosis is made, its diagnostic value is limited by equivocal interpretations.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Diagnostic Accuracy Studies
Background:
- Intussusception is a common surgical emergency in children.
- Abdominal radiographs (AXR) are frequently used to evaluate suspected intussusception.
- Interobserver variability in interpreting AXR can impact diagnostic accuracy.
Purpose of the Study:
- To assess interobserver variation in the interpretation of abdominal radiographs for suspected intussusception in children.
- To determine the diagnostic value of abdominal radiographs in pediatric intussusception.
Main Methods:
- Retrospective review of 182 abdominal radiographs in children with suspected intussusception.
- Blind assessment of nine AXR signs by three independent observers.
- Calculation of interobserver agreement using kappa statistics.
- Comparison with air enema findings as the gold standard.
Main Results:
- Overall agreement for intussusception diagnosis was low (kappa = 0.30).
- Observer agreement varied significantly for specific AXR signs.
- Abdominal radiographs were equivocal in 53% of cases.
- Diagnostic accuracy was 84% when a firm radiographic diagnosis was made.
Conclusions:
- Significant interobserver variation exists in interpreting abdominal radiographs for intussusception.
- The diagnostic value of AXR is limited by frequent equivocal findings.
- Clinical correlation and further imaging may be necessary for definitive diagnosis.