Donna Mendez1, A Chantal Caviness, Long Ma, Charles C Macias. 1. Pediatrics/Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. drmendez@texaschildrens.org
Abstract
OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception. DESIGN: This was a retrospective cross-sectional study of children 3 years or younger with signs and symptoms of intussusceptions who presented to a pediatric emergency department (ED). Univariate analysis, multivariate analysis, and diagnostic accuracy of clinical characteristics and radiographic findings were derived. RESULTS: A highly suggestive abdominal radiograph (14.80; 5.85-37.45), right upper quadrant mass (8.90; 1.14-69.47), vomiting (2.54; 1.36-4.76), and abdominal pain (2.45; 1.36-4.40) were found to be significantly associated with intussusception by univariate analysis. Vomiting (2.80; 1.34-5.85), abdominal pain (2.75; 1.33-5.69), and bloody stools (2.70; 1.07-6.81) were independently associated with intussusceptions by multivariate analysis. Bloody stools were time dependent. Bloody stools occurred in those patients with intussusception at a median time of 24 hours, from the time the patient started with signs and symptoms to the time of presentation to the ED, vs those without bloody stools presenting at a median time of 11 hours. The combination of a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting was highly specific (95%) for intussusception, comparable to that of an ultrasound (93%). In patients with this combination, all were found to have intussusception by enema or surgery. CONCLUSIONS: Ultrasound is not needed before an enema for the diagnosis of intussusception for those with a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting.
OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception. DESIGN: This was a retrospective cross-sectional study of children 3 years or younger with signs and symptoms of intussusceptions who presented to a pediatric emergency department (ED). Univariate analysis, multivariate analysis, and diagnostic accuracy of clinical characteristics and radiographic findings were derived. RESULTS: A highly suggestive abdominal radiograph (14.80; 5.85-37.45), right upper quadrant mass (8.90; 1.14-69.47), vomiting (2.54; 1.36-4.76), and abdominal pain (2.45; 1.36-4.40) were found to be significantly associated with intussusception by univariate analysis. Vomiting (2.80; 1.34-5.85), abdominal pain (2.75; 1.33-5.69), and bloody stools (2.70; 1.07-6.81) were independently associated with intussusceptions by multivariate analysis. Bloody stools were time dependent. Bloody stools occurred in those patients with intussusception at a median time of 24 hours, from the time the patient started with signs and symptoms to the time of presentation to the ED, vs those without bloody stools presenting at a median time of 11 hours. The combination of a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting was highly specific (95%) for intussusception, comparable to that of an ultrasound (93%). In patients with this combination, all were found to have intussusception by enema or surgery. CONCLUSIONS: Ultrasound is not needed before an enema for the diagnosis of intussusception for those with a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting.
Authors: Lan Anh T Tran; Lay Myint Yoshida; Toyoko Nakagomi; Punita Gauchan; Koya Ariyoshi; Dang Duc Anh; Osamu Nakagomi; Vu Dinh Thiem Journal: Trop Med Health Date: 2013-08-20