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Published on: February 2, 2015
Ultrasound compared with clinical examination in infantile hypertrophic pyloric stenosis
P Godbole1, A Sprigg, J A Dickson
1Department of Paediatric Surgery, Sheffield Children's Hospital.
Insights
Ultrasound imaging is more accurate than clinical examination for diagnosing infantile hypertrophic pyloric stenosis, reducing diagnostic errors and improving patient outcomes. This study highlights the importance of skilled sonographers for accurate diagnosis.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Neonatal Care
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical emergency in infants.
- Accurate and timely diagnosis is crucial for optimal patient outcomes.
- Clinical examination and ultrasound imaging are primary diagnostic tools.
Purpose of the Study:
- To compare the diagnostic accuracy of clinical examination versus ultrasound imaging for IHPS.
- To evaluate associated factors like hospital stay, time to surgery, and financial implications.
Main Methods:
- Prospective study of 116 infants with suspected IHPS.
- Comparison of diagnostic accuracy metrics (sensitivity, specificity, predictive values) between clinical exam and ultrasound.
- Analysis of hospital stay, time to surgery, and costs.
Main Results:
- Ultrasound imaging demonstrated higher sensitivity (97%) and specificity (100%) compared to clinical examination (72% sensitivity, 97% specificity).
- Ultrasound had fewer diagnostic errors (1 vs. 16).
- Ultrasound identified cases missed by clinical examination, impacting management decisions.
Conclusions:
- Ultrasound imaging is a more accurate diagnostic tool for IHPS than clinical examination.
- Ultrasound should be utilized in cases with negative clinical findings.
- Expertise of sonographers is vital for maintaining diagnostic accuracy with ultrasound.
Objectives:
To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered.
Design:
A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995.
Setting:
Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital.
Subjects:
116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis.
Results:
75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds.
Conclusion:
Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.
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