Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

Abstract

Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

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

“…As interest in using POCUS continues to grow within pediatric EDs, it is important to develop evidence-based implementation strategies that improve patient outcomes without compromising safety. Recent research has focused on the use of POCUS for intussusception and has shown that POCUS has high sensitivity, specificity, and diagnostic accuracy for this application when compared with RADUS 4–6,9,21–26 . The use of POCUS for the evaluation of intussusception has several potential benefits to patients, including improvement of patient throughput in the ED, focusing the need for further diagnostic testing, and informing decisions regarding transfer from general to pediatric centers.…”

“…Recent research has focused on the use of POCUS for intussusception and has shown that POCUS has high sensitivity, specificity, and diagnostic accuracy for this application when compared with RADUS. [4][5][6]9,[21][22][23][24][25][26] The use of POCUS for the evaluation of intussusception has several potential benefits to patients, including improvement of patient throughput in the ED, focusing the need for further diagnostic testing, and informing decisions regarding transfer from general to pediatric centers. In one recent multicenter study, 38% of children transferred from an outside hospital had a negative intussusception evaluation at the receiving hospital, suggesting that these transfers may have been avoidable assuming there were no other indications for transfer.…”

Current diagnosis and image-guided reduction for intussusception in children: teamwork approach

“…2) Although point-of-care USG by trained pediatric emergency physicians had high sensitivity (100%) and specificity (95.6%), 3) abdominal USG is usually performed by a radiologist rather than a pediatrician or emergency physician because most pediatric intussusception is managed in training hospitals in Korea. 4) The advantage of performing USG by radiologists is that other findings can determine the failure of enema reduction, 5) including the blood supply status of the intussusception, presence of intestinal necrosis or ascites, and the pathologic leading causes can also be confirmed.…”