Diagnosis of Pediatric Intussusception by an Emergency Physician-Performed Bedside Ultrasound

Kairam, N.; Kaiafis, Costas; Shih, Richard D.

doi:10.1097/pec.0b013e31819a8a46

Cited by 31 publications

(11 citation statements)

References 24 publications

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“…[7][8][9][10] Though these study results have been encouraging, a recent review concluded that the value of BUS to rule out intussusception has yet to be proven due to "clinically unacceptable" reported sensitivities, and that further studies would be necessary due to relatively small sample sizes. [11] Our results were similar to the conclusions of the two published trials, in which emergency physicians with focused training could diagnose pediatric intussusception accurately with BUS.…”

Section: Resultsmentioning

confidence: 99%

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

Lam

Wise

Yenter

2014

World Journal of Emergency Medicine

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BACKGROUND: Ultrasound diagnosis of pediatric intussusception is feasible with limited operator training. The authors report the test characteristics of bedside ultrasound (BUS) for the diagnosis of pediatric intussusception at a single institution.METHODS: Inclusion criteria were: 1) patients of 0-18 years old were seen in the pediatric emergency department (ED) with a clinical presentation suspicious for intussusception; 2) BUS was performed to identify intussusception and bedside impression documented in the medical record; 3) a "formal" diagnostic study (such as computed tomography, ultrasound, or barium enema) was performed by the radiology department after BUS was completed. Electronic medical record and ED BUS archive were screened for potentially eligible ED visits between January 1 st 2009 to October 3 rd 2012. These records were then reviewed to identify patients for inclusion in the study. All emergency physicians who performed the BUS had undergone a minimum of 1-hour didactic training on the use of BUS to diagnose pediatric intussusception. RESULTS:A total of 1 631 charts were reviewed, with 49 meeting inclusion criteria. Five of those were later excluded for incomplete documentation or lack of saved BUS images. The prevalence of intussusception was 23%. The mean age of the subjects was 31 months. BUS was 100% sensitive (95%CI 66%-100%) and 94% specifi c (95%CI 79%-99%) for detection of pediatric intussusception compared to radiology study results. Positive and negative likelihood ratios were 16.5 (95%CI 4.30%-63.21%) and 0 (95%CI 0-0) respectively. CONCLUSIONS: BUS is an accurate means of diagnosing acute intussusception in pediatric patients. Further study might be indicated to confi rm such benefi ts.

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Section: Resultsmentioning

confidence: 99%

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

Lam

Wise

Yenter

2014

World Journal of Emergency Medicine

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“…Case reports of emergency physicians diagnosing intussusception using bedside ultrasound (BUS) exist. 4 To our knowledge, no study to date has compared the accuracy of BUS performed by emergency physicians to diagnostic radiology (DR) ultrasounds for the diagnosis of ileo-colic intussusception.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Intussusception by Physician Novice Sonographers in the Emergency Department

Riera

Hsiao

Langhan

et al. 2012

Annals of Emergency Medicine

105

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Objective To investigate the performance characteristics of bedside emergency department ultrasound by non-radiologist, physician sonographers in the diagnosis of ileo-colic intussusception in children. Methods This was a prospective, observational study conducted in a pediatric emergency department of an urban tertiary care children’s hospital. Pediatric emergency medicine (PEM) physicians with no previous experience in bowel ultrasound underwent a focused one-hour training session conducted by a pediatric radiologist. The session included a didactic component on sonographic appearances of ileo-colic intussusception, review of positive and negative images for intussusceptions, and a hands-on component using a live child model. Upon completion of the training a prospective convenience sample study was performed. Children were enrolled if they were to undergo a diagnostic radiology (DR) ultrasound for suspected intussusception. Bedside ultrasound (BUS) by trained PEM physicians were performed and interpreted as either positive or negative for ileo-colic intussusception. Ultrasound studies were then performed by DR and their results were used as the reference standard. Test characteristics (sensitivity, specificity, positive and negative predictive values) and likelihood ratios were calculated. Results Six PEM physicians completed the training and performed the bedside studies. Eighty two patients were enrolled. The median age was 25 months (range 3 months – 127 months). Thirteen patients (16%) were diagnosed with ileo-colic intussusception by DR. BUS had a sensitivity of 85% (95% confidence interval [CI] 54% to 97%), specificity of 97% (95% CI 89% to 99%), positive predictive value of 85% (95% CI 54% to 97%) and negative predictive value of 97% (95% CI 89% to 99%). A positive BUS had a likelihood ratio of 29 (95% CI 7.3 to 114) and a negative BUS had a likelihood ratio of 0.16 (95% CI 0.04 to 0.57). Conclusions With limited and focused training, PEM physicians can accurately diagnose ileo-colic intussusception in children using BUS.

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“…Complicated appendicitis with shock usually yields moderate peritoneal effusion, which can be punctured. Intussusception yields suggestive signs on occasion [16]. Among some signs of midgut volvulus, the superior mesenteric artery can be seen right to the vein (the "whirlpool sign").…”

Section: Miscellaneousmentioning

confidence: 97%

Gastrointestinal Tract

Lichtenstein¹

2010

Whole Body Ultrasonography in the Critically Ill

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Diagnosis of Pediatric Intussusception by an Emergency Physician-Performed Bedside Ultrasound

Cited by 31 publications

References 24 publications

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review

Diagnosis of Intussusception by Physician Novice Sonographers in the Emergency Department

Gastrointestinal Tract

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