Clinical Case Definition for the Diagnosis of Acute Intussusception

Bines, Julie E; Ivanoff, B; Justice, Frances; Mulholland, Kim

doi:10.1097/00005176-200411000-00012

Cited by 78 publications

(62 citation statements)

References 25 publications

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“…The study confirms previous findings of a retrospective valic c dation study performed at a tertiary care paediatric hospital in Australia. 8 The defic c nition has already been used successfully in clinical trials of a rotavirus vaccine in which more than 65 000 infants in Latin America and Asia participated.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical case definition that was developed showed promise (sensic c tivity = 97%; specificity = 87-91%) in a retrospective study in a tertiary care hospital in Australia. 8 The aim of this study was to validate the clinical case definition for intussusception by asc c sessing the performance of the criteria prospectively in parallel studies in a developed country and in a developing country where there is a high incidence of intussusception. Each component of the definition was analysed to assess the reliability of individual symptoms and signs as well as groups of symptoms and signs to assess the sensitivity and specificc c ity of the definition.…”

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confidence: 99%

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Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

Bines

Liêm

Justice

et al. 2006

Bull World Health Organ

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Objective To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. Methods Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants aged < 2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged < 2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). Findings In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). Conclusion The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely. Voir page 574 le résumé en français. En la página 574 figura un resumen en español. IntroductionThe withdrawal of the first rotavirus vacc c cine to be licensed in the United States (RotaShield, Wyeth-Lederle Vaccines, Philadelphia, PA, United States), due to an unexpected association with intusc c susception, resulted in a major setback in the effort to reduce the global burden of rotavirus gastroenteritis.1-3 Although the risk of intussusception following imc c munization with RotaShield is low, it has posed a major challenge to the future development of a safe and effective vacc c cine.2 Largecscale clinical trials are now required to detect a risk of intussusception of < 1 in 10 000. [4][5][6] Baseline intussuscepc c tion surveillance is needed in sites where trials of rotavirus vaccines are planned, and postclicensure intussusception surc c veillance may also be required by some licensing agencies. Intussusception is the invagination of the bowel by a more proximal segment. The intussusception can be propelled disc c tally by peristalsis, resulting in intestinal obstruction and vascular compromise of the intestine. Prompt identification and reduction by air enema or hydrostatic enema or by surgery is vital to minimize the morbidity and mortality that may be associat...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

Bines

Liêm

Justice

et al. 2006

Bull World Health Organ

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“…In order to overcome these drawbacks, Bines et al [4] formulated a clinical case definition for the diagnosis of intussusception. With a sensitiveness of 97% and specificity that ranged between 87% and 91%, this may be a very helpful tool especially in places with limited facilities.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

Tagbo¹,

Mwenda²,

Eke³

et al. 2014

WJV

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124(15.6%) and abnormal/absent bowel sound 43 (15.9%). Diagnosis was essentially with the aid of abdominal ultrasonography, 38 (63.3%) while surgery (laparotomy) was the treatment of choice in most cases 48 (80.0%). The case fatality rate was 3 (5.0%). Conclusion: None of the cases studied could be directly linked to rotavirus vaccinations. But seasonal peak incidence coincided with rotavirus diarrhea peak incidence. Efforts should be made to institute post-rotavirus vaccine licensure prospective surveillance study in order to fully determine any relationship between rotavirus vaccination and intussusception in Enugu, South east, Nigeria.

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“…[1][2][3] Pneumatic or hydrostatic enema reduction has become the standard of care for treatment of intussusception in otherwise healthy children, with operative management being reserved for complicated cases (e.g., signs of peritonitis or suspicion of perforation, hemodynamic instability, pathologic lead point) or those who have failed enema reduction. 4,5 Enema reduction has been shown by multiple studies to have a success rate between 70 and 91%.…”

mentioning

confidence: 99%

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

Lessenich

Kimia

Mandeville

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to determine the frequency of postreduction, hospital-level interventions among children with successful reduction of ileocolic intussusception and identify factors that predict the need for such interventions.Methods: This was a retrospective cross-sectional study of children who underwent successful enema reduction for ileocolic intussusception at a single emergency department. Hospital-level interventions were included if they occurred within 24 hours of reduction and were further classified as either major (recurrence or possible perforation) or minor (imaging for suspected recurrence or administration of parenteral narcotics or antiemetics). Binary logistic regression was used to identify predictors for hospital-level interventions.Results: A total of 464 children underwent enema reduction. The median age was 1.7 years (interquartile range [IQR] = 0.8 to 2.5 years), and 66% were male. A total of 435 (94%) were hospitalized with a median hospital stay of 25 hours (IQR = 19 to 34 hours). Nineteen percent (95% confidence interval [CI] = 15% to 22%) needed postreduction interventions, including 6% (95% CI = 4% to 9%) who required major interventions. The median time to any hospital intervention was 9.9 hours (IQR = 6.3 to 16.4 hours). We identified two independent predictors for hospital-level interventions: duration of symptoms > 24 hours (adjusted odds ratio [OR] = 2.1, 95% CI = 1.3 to 3.4) and location of the intussusception tip at (or proximal to) the hepatic flexure (adjusted OR = 1.9, 95% CI = 1.1 to 3.3); the latter factor was also a predictor of a major intervention. None of the children (95% CI = 0 to 1.0%) had an acute decompensation after an initially successful enema reduction.Conclusions: Clinical decompensation is rare and recurrence is relatively low after an uncomplicated reduction of ileocolic intussusception. However, one in five children required hospital-level interventions after reduction. Children with the intussusception tip at (or proximal to) the hepatic flexure, and those with symptoms for longer than 24 hours, are more likely to require subsequent interventions. Although outpatient management appears safe after a period of observation, caregivers should be counseled about the risk of ongoing symptoms and recurrence.

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Clinical Case Definition for the Diagnosis of Acute Intussusception

Abstract: The clinical case definition for intussusception may assist in the prompt identification of patients with intussusception and may provide an important tool for the future trials of enteric vaccines.

Cited by 78 publications

References 25 publications

Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

Retrospective Evaluation of Intussusception in Under-Five Children in Nigeria

The Frequency of Postreduction Interventions After Successful Enema Reduction of Intussusception

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