Study Objectives: Intussusception is a pediatric abdominal emergency that requires prompt diagnosis, as delays can lower air enema reduction success rates. Point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians has emerged as a promising tool for diagnosing intussusception. The primary objective of this study was to evaluate the accuracy of PEM physician-performed POCUS in identifying ileocolic intussusception. The secondary objective was to identify factors that predict air enema failure.Methods: This retrospective study included children who underwent POCUS for suspected ileocolic intussusception in a pediatric emergency department. Patients were included in the study if they presented between January 2001 and December 2015, and had POCUS performed by one of three PEM physicians. PEM physicians were trained in standard POCUS techniques/indications, and subsequently underwent brief additional education in identification of ileocolic intussusception. A pediatric radiologist confirmed POCUS scan interpretation by either direct over-read of the POCUS images, or by radiology department ultrasound. Data collected included demographic variables, duration of symptoms, location of intussusception, air enema success/failure, need for surgery, and recurrence of intussusception. Data analysis included descriptive statistics, sensitivity, specificity, and positive and negative predictive values of POCUS.Results: 105 POCUS scans were performed on 104 patients. Mean age was 22 months (range 2 to 88 months) and 67/104 (64.4%) were male. There were 78 patients with intussusception; 75/78 were detected by POCUS (Figure 1). PEM physician-performed POCUS had a sensitivity of 96.2% (95% CI 91.9-99.2), specificity of 92.6% (95% CI 82.7-100), positive predictive value of 97.4% (95% CI 93.9-100), and negative predictive value of 89.3% (95% CI 77.8-100). Seventy-five children underwent air enema, 54 had successful reduction, and 21 required surgery. Three children had spontaneous resolution and did not require air enema. Intussusception distal to the splenic flexure was found to be associated with unsuccessful air enema (OR 11.48, p¼<0.01). Sex, duration of symptoms, and history of recurrent intussusception were not found to be predictors of air enema failure.Conclusions: PEM physician-performed POCUS accurately identified ileocolic intussusception when compared with radiologist interpretation. Intussusception located distal to the splenic flexure was a strong predictor of air enema failure. POCUS is a promising diagnostic modality in prompt diagnosis of intussusception, but needs further prospective study.
Background: Occasionally low grade gliomas (LGGs) are identified incidentally while asymptomatic. The diagnosis of incidental LGGs has become more frequent due to increase in access to medical imaging. While management of these lesions remains controversial, early surgery has been suggested to improve outcome. Methods: All LGGs treated between 2004 and 2016 at our institution were reviewed. Patients with incidentally discovered glioma were identified and retrospectively reviewed. “Incidental” was defined as an abnormality on imaging that was obtained for a reason not attributable to the glioma. Outcomes were measured by overall survival, progression free survival and malignant progression free survival. Results: Thirty-four out of 501 adult patients who were treated for low grade glioma were discovered incidentally. Headache (26%, n=9) and screening (21%, n=7) were the most common indications for brain imaging. The mean duration follow up was 5 years. Twelve patients had disease progression, 5 cases of malignant progression and 4 deaths. Oligodendroglioma was diagnosed in 16 and astrocytoma in 15 patients. Twenty-five (74%) patients had IDH1 mutation and demonstrated prolonged survival. Conclusions: This retrospective cohort of incidentally discovered LGGs were surgically removed with minimal surgical risk. There is improved overall survival likely attributable to the underlying favorable biology of the disease indicated by the presence of IDH1 mutation.
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