Pediatric Emergency Medicine Point-of-Care Ultrasound for the Diagnosis of Intussusception.

Abstract

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. 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. 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. One hundred and two POCUS examinations were completed on 101 patients who met the inclusion criteria. The mean age of patients was 22months. 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 <6months (OR=6.83 [95% CI 1.94-24.09]; p<0.01). PEM POCUS identifies intussusception with high sensitivity and specificity. Patients <6months old or with intussusception distal to the splenic flexure had a higher risk of air enema failure.