Abstract
Background
Delayed diagnosis of intussusception can lead to air enema failure and increased morbidity.
There are limited studies reporting the accuracy of pediatric emergency medicine (PEM)
physician point-of-care ultrasound (POCUS) in diagnosing intussusception.
Objectives
The primary objective was to evaluate the accuracy of PEM POCUS in identifying ileocolic
intussusception. The secondary objective was to identify factors associated with air
enema failure.
Methods
This was a retrospective study of children who underwent POCUS for suspected intussusception
in a pediatric emergency department between January 2001 and December 2015. Patients
were included if a pediatric radiologist confirmed the POCUS examination interpretation
by image review, radiology department ultrasound, or air enema. Age, symptom duration,
recurrent intussusception, and location of intussusception were examined as factors
for air enema failure.
Results
One hundred and two POCUS examinations were completed on 101 patients who met the
inclusion criteria. The mean age of patients was 22 months. Of 75 patients with intussusception,
72 were detected with POCUS. PEM POCUS had a sensitivity of 96.0% (95% confidence
interval [CI] 91.6–100.0%), specificity of 92.6% (95% CI 82.7–100.0%), positive predictive
value of 97.3% (95% CI 93.6–100.0%), and negative predictive value of 89.3% (95% CI
77.8–100.0%). Air enema failure was associated with intussusception distal to the
splenic flexure (odds ratio = 10.00 [95% CI 2.81–35.61]; p < 0.01) and age <6 months (OR = 6.83 [95% CI 1.94–24.09]; p < 0.01).
Conclusion
PEM POCUS identifies intussusception with high sensitivity and specificity. Patients
<6 months old or with intussusception distal to the splenic flexure had a higher risk
of air enema failure.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intussusception.Pediatr Emerg Care. 2008; 24: 793-800
- Intussusception: past, present and future.Pediatr Radiol. 2017; 47: 1101-1108
- Diagnosis of intussusception by physician novice sonographers in the emergency department.Ann Emerg Med. 2012; 60: 264-268
- Predictors of failed enema reduction in childhood intussusception.J Pediatr Surg. 2012; 47: 925-927
- Surgical approach to intussusception in older children: Influence of lead points.J Pediatr Surg. 2015; 50: 647-650
- Management of recurrent intussusception: nonoperative or operative reduction?.J Pediatr Surg. 2010; 45: 2175-2180
- Childhood intussusception: hydrostatic reducibility and incidence of leading points in different age groups.Pediatr Radiol. 1980; 10: 83-86
- Diagnosis of intussusception using bedside ultrasound by a pediatric resident in the emergency department.Hawaii J Med Public Health. 2014; 73: 58-60
- Diagnostic emergency ultrasound: assessment techniques in the pediatric patient.Pediatr Emerg Med Pract. 2016; 13: 1-8
- Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception.Pediatr Radiol. 2009; 39: 1075-1079
- Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam.Pediatr Radiol. 2007; 37: 195-199
- Pediatric emergency medicine point-of-care ultrasound: summary of the evidence.Crit Ultrasound J. 2016; 8: 16
- Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review.World J Emerg Med. 2014; 5: 255-258
- Emergency medicine physicians performed ultrasound for pediatric intussusceptions.Biomed J. 2012; 36: 175-178
- Failure of enema reduction for ileocolic intussusception at a referring hospital does not preclude repeat attempts at a children’s hospital.J Pediatr Surg. 2010; 45: 1178-1181
- Significance of age, duration, obstruction and the dissection sign in intussusception.Pediatr Radiol. 1990; 20: 454-456
- The role of laparoscopy in the management of childhood intussusception.Surg Endosc. 2001; 15: 373-376
- American College of Emergency Physicians emergency ultrasound guidelines–2001.Ann Emerg Med. 2001; 38: 470-481
- Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.J Biomed Inform. 2009; 42: 377-381
- Intussusception in children: can we rely on screening sonography performed by junior residents?.Pediatr Radiol. 2004; 34: 134-137
- Intussusception in children: reliability of US in diagnosis--a prospective study.Radiology. 1992; 184: 741-744
- Pneumatic reduction of childhood intussusception. Is prediction of failure important?.J Pediatr Surg. 2007; 42: 1504-1508
- Intussusception: factors related to treatment.Arch Dis Child. 1990; 65: 871-873
- Success with hydrostatic reduction of intussusception in relation to duration of symptoms.Arch Dis Child. 2005; 90: 1071-1072
- Intussusception. Part 3: diagnosis and management of those with an identifiable or predisposing cause and those that reduce spontaneously.Pediatr Radiol. 2004; 34: 305-312
Article info
Publication history
Published online: August 09, 2019
Accepted:
June 8,
2019
Received in revised form:
May 12,
2019
Received:
February 7,
2019
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
