Abstract
IntroductionIleocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception by emergency physicians (EP).MethodsWe conducted a systematic search on PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, as well as conference abstracts, and assessed bibliographies of selected articles for all studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. We dual extracted data into a predefined worksheet and performed quality analysis with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed.ResultsSix studies (n = 1303 children) met our inclusion criteria. Overall, 11.9% of children had intussusception. POCUS was 94.9% (95% confidence interval [CI], 89.9% to 97.5%) sensitive and 99.1% (95% CI, 94.7% to 99.8%) specific with a likelihood ratio (LR)+ of 105 (95% CI, 18 to 625) and a LR− of 0.05 (95% CI, 0.03 to 0.10).ConclusionPOCUS by EPs is highly sensitive and specific for the identification of intussusception for children presenting to the emergency department.
Highlights
Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints
Point-of-care ultrasound (POCUS) was 94.9% (95% confidence interval [confidence intervals (CI)], 89.9% to 97.5%) sensitive and 99.1% specific with a likelihood ratio (LR)+ of 105 and a LR− of 0.05
POCUS by emergency physicians (EP) is highly sensitive and specific for the identification of intussusception for children presenting to the emergency department. [West J Emerg Med. 2020;21(4)1008-1016.]
Summary
Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. Ileocolic intussusception is the most common cause of gastrointestinal obstruction in children and represents a common abdominal emergency in early childhood.[1] As the ileum telescopes into the cecum, the mesentery is compressed, which leads to venous and lymphatic bowel congestion. Since the majority of cases are seen in children aged 6-36 months,[1] the history is often limited, which can compound the difficulty of diagnosis
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