Abstract
BackgroundThis study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage.MethodsThis 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.ResultsWe 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 h, 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.ConclusionPOCUS 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.
Highlights
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
Intussusception is a significant cause of intestinal obstruction in the pediatric population, and it necessitates a visit to the emergency department (ED) [1]
Pocus The criteria for performing POCUS were set to broader standards to detect intussusception at an early stage wherein POCUS was performed in the presence of the following symptoms: any one of intermittent abdominal pain/irritability or bloody stool, otherwise at least two symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy
Summary
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. Intussusception is a significant cause of intestinal obstruction in the pediatric population, and it necessitates a visit to the emergency department (ED) [1]. Intussusception is often alleviated by therapeutic air or liquid enema, but a delay in diagnosis may lead to intestinal gangrene, perforation, and peritonitis, which may require unexpected surgery [2]. Detecting intussusception by evaluating the clinical features or plain abdominal radiographs may be challenging [3]. The sensitivity of radiographs interpreted by pediatric emergency physicians was disappointingly low as 48% [5]. Multiple views of abdominal plain radiographs interpreted by an experienced radiologist might
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