A Multi-institutional Case Series With Review of Point-of-Care Ultrasound to Diagnose Malrotation and Midgut Volvulus in the Pediatric Emergency Department

Garcia, Angelica M.; Asad, Imran; Tessaro, Mark O.; Sivitz, Adam; Osborn, Katharine A; Shaahinfar, Ashkon; Leung, Siu N.; Rowe, Erin; Riera, Antonio

doi:10.1097/pec.0000000000001737

Cited by 10 publications

(5 citation statements)

References 11 publications

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“…6,9,10 The diagnostic findings in Doppler US are twisting of SMV around SMA, namely whirlpool sign, and inversion of SMA and SMV course. 10,13 Although it is dependent on the experience of radiologist, it can also be performed as a fast diagnostic method called point-of-care US especially in emergency conditions. 13 However, normal SMA and SMV course does not exclude malrotation 14 as we found in our study.…”

Section: Discussionmentioning

confidence: 99%

“…10,13 Although it is dependent on the experience of radiologist, it can also be performed as a fast diagnostic method called point-of-care US especially in emergency conditions. 13 However, normal SMA and SMV course does not exclude malrotation 14 as we found in our study. In the present study, we performed Doppler US in 20 cases with high sensitivity (92.3%) but relatively lower specificity (85.7%).…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation

et al. 2022

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Background. To evaluate the predictability of clinical and radiological findings in the diagnosis of malrotation. Methods. Between 2010 and 2020, children with presumptive diagnosis of malrotation were included. The demographic features, clinical and radiological findings, operative findings and outcome were recorded. The upper gastrointestinal series (UGIS) were evaluated by two radiologists. All parameters were correlated with surgical findings to evaluate the predictability. Results. Seventy patients were included. The presenting symptom was bilious vomiting in 29 cases (41.4%), and atypical symptoms (non-bilious vomiting, food refusal, etc.) in 40 cases (57%). One of the cases (1.6%) was asymptomatic and diagnosed incidentally during UGIS. 52 cases had abdominal X-ray and 14 (26.9%) of them were normal. Doppler ultrasonography (US) (n=20) revealed evidence of malrotation in 13 cases (65%). The location of duodenojejunal junction (DJJ) in UGIS was compatible with malrotation in 33 cases. 48 (61%) cases underwent surgical exploration; 35 cases had malrotation and seven cases had midgut volvulus. Median followup time was one year (0.5-7 years). Volvulus has recurred in one case and another case operated for volvulus died because of short bowel syndrome. The statistical analysis for predictability revealed that bilious vomiting (sensitivity: 57.1%, specificity: 82.1%), Doppler US (sensitivity: 92.3%, specificity: 75%) and right-sided DJJ in UGIS (sensitivity: 96.8%, specificity: 75%) have highest predictability. Conclusions. The bilious vomiting, Doppler US findings and right-sided DJJ have the highest predictability to confirm the diagnosis. However, presenting with atypical symptoms and having atypical or normal findings in UGIS do not rule out malrotation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation

et al. 2022

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“…Point-of-care ultrasound (POCUS) has been shown to be a useful adjunct for the evaluation of pediatric abdominal complaints 1–3 . Recent investigations have shown that POCUS performs similarly to radiology-performed ultrasound (RADUS) for the identification of intussusception, with a diagnostic accuracy ranging from 92% to 98% 4–9 .…”

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confidence: 99%

“…P oint-of-care ultrasound (POCUS) has been shown to be a useful adjunct for the evaluation of pediatric abdominal complaints. [1][2][3] Recent investigations have shown that POCUS performs similarly to radiology-performed ultrasound (RADUS) for the identification of intussusception, with a diagnostic accuracy ranging from 92% to 98%. [4][5][6][7][8][9] However, routine use of POCUS for the evaluation of intussusception has been limited, in part due to varying levels of sonography experience among staff members and the relative nascency of POCUS within the field of pediatric emergency medicine (PEM).…”

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confidence: 99%

Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception

et al. 2022

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The aim of this study was to determine the accuracy and interrater reliability of (1) point-of-care ultrasound (POCUS) image interpretation for identification of intussusception and (2) reliability of secondary signs associated with intussusception among experts compared with novice POCUS reviewers. Methods:We conducted a planned secondary analysis of a prospective, convenience sample of children aged 3 months to 6 years who were evaluated with POCUS for intussusception across 17 international pediatric emergency departments between October 2018 and December 2020. A random sample of 100 POCUS examinations was reviewed by novice and expert POCUS reviewers. The primary outcome was identification of the presence or absence of intussusception. Secondary outcomes included intussusception size and the presence of trapped free fluid or echogenic foci. Accuracy was summarized using sensitivity and specificity, which were estimated via generalized mixed effects logistic regression. Interrater reliability was summarized via Light's κ statistics with bootstrapped standard errors (SEs). Accuracy and reliability of expert and novice POCUS reviewers were compared.Results: Eighteen expert and 16 novice POCUS reviewers completed the reviews. The average expert sensitivity was 94.5% (95% confidence interval [CI], 88.6-97.5), and the specificity was 94.3% (95% CI, 90.3-96.7), significantly higher than the average novice sensitivity of 84.7% (95% CI, 74.3-91.4) and specificity of 80.4% (95% CI, 72.4, 86.7). κ was significantly greater for expert (0.679, SE 0.039) compared with novice POCUS reviewers (0.424, SE 0.044; difference 0.256, SE 0.033). For our secondary outcome measure of intussusception size, κ was significantly greater for experts (0.661, SE 0.038) compared with novices (0.397, SE 0.041; difference 0.264, SE 0.029). Interrater reliability was weak for expert and minimal for novice reviewers regarding the detection of trapped free fluid and echogenic foci.Conclusions: Expert POCUS reviewers demonstrate high accuracy and moderate interrater reliability when identifying intussusception via image interpretation and perform better than novice reviewers.

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“…If these two master sonographers could not, how could the rest of us? Some practices, mostly outside the United States, have further pursued US for the diagnosis of malrotation [3][4][5][6][7][8][9][10][11][12]. Some have achieved substantial success.…”

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confidence: 99%

Ultrasound for malrotation and volvulus: has the time come?

Strouse

2021

Pediatr Radiol

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A Multi-institutional Case Series With Review of Point-of-Care Ultrasound to Diagnose Malrotation and Midgut Volvulus in the Pediatric Emergency Department

Cited by 10 publications

References 11 publications

Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation

Evaluation of the predictability of clinical and radiological findings in the diagnosis of malrotation

Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception

Ultrasound for malrotation and volvulus: has the time come?

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