Pediatric emergency gastrointestinal ultrasonography: pearls &amp; pitfalls

Meister, Moshe; Alharthi, Omar; Kim, Jane S.; Son, Jennifer K.

doi:10.1016/j.clinimag.2020.03.002

Cited by 8 publications

(7 citation statements)

References 59 publications

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“…There were 6 false-positives in this study; however, no patient underwent unnecessary surgery because additional RADUS was performed in all patients in whom HPS was suspected on POCUS. Considering that HPS can be confused with pyloric spasm on ultrasound and 2 patients with pyloric spasm in our study were misdiagnosed with HPS initially with POCUS, it may be necessary to observe the pylorus for a longer time or confirm the finding using RADUS 10,24 . Additional RADUS was performed in 16 patients who showed no HPS on POCUS but had persistent vomiting during the ED stay.…”

Section: Discussionmentioning

confidence: 94%

“…Considering that HPS can be confused with pyloric spasm on ultrasound and 2 patients with pyloric spasm in our study were misdiagnosed with HPS initially with POCUS, it may be necessary to observe the pylorus for a longer time or confirm the finding using RADUS. 10,24 Additional RADUS was performed in 16 patients who showed no HPS on POCUS but had persistent vomiting during the ED stay. Only 1 false-negative was observed, and the patient was managed appropriately.…”

Section: Discussionmentioning

confidence: 99%

“…8 Radiologist-performed ultrasound (RADUS) for diagnosing HPS has been widely used as a confirmatory imaging modality 9 ; however, the varying availability of radiology may increase the overall length of stay in the ED (EDLOS). Recently, several studies have reported on the diagnostic yield of point-ofcare ultrasound (POCUS) performed by emergency physicians for various pediatric conditions, [10][11][12][13] and a pilot study in which 10 cases of HPS among 67 patients were diagnosed by pediatric emergency physicians performing POCUS showed promising results, with 100% sensitivity and 100% specificity. 14 These results suggest that POCUS may be a useful tool for the diagnosis of HPS in the ED; however, larger scale studies are needed.…”

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confidence: 99%

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Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department

et al. 2021

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Objectives: This study aimed to investigate the feasibility of point-ofcare ultrasound (POCUS) for diagnosing hypertrophic pyloric stenosis (HPS) in the emergency department (ED).Methods: A retrospective study was conducted in infants aged younger than 90 days who were brought to the ED due to vomiting between January 2015 and December 2019. Of these, infants who were clinically suspected of having HPS and underwent ultrasound were included and categorized into 3 groups: POCUS only, POCUS followed by radiologist-performed ultrasound (RADUS), and RADUS only. All confirmative diagnoses of HPS were made by RADUS. The diagnostic performance of POCUS was analyzed, and the ED patient flow was compared between the POCUS-performed (POCUS only or POCUS followed by RADUS) and RADUS-only groups.Results: Overall, 171 patients with a median age of 34 days were included. Of these, 79 patients (46.2%) underwent POCUS only, and none had HPS; 50 patients (29.2%) underwent POCUS followed by RADUS; and 42 patients (24.5%) underwent RADUS only. Overall, 41 patients (24.0%) were diagnosed with HPS, and POCUS showed a sensitivity of 96.6% and specificity of 94.0%. In the total cohort, length of stay in the ED (EDLOS) was shorter in the POCUS-performed group than in the RADUS-only group (2.6 vs 3.8 hours, P = 0.015). Among non-HPS patients, time to disposition (1.8 vs 2.7 hours, P = 0.005) and EDLOS (2.0 vs 3.0 hours, P = 0.004) were shorter in the POCUS-performed group than in the RADUS-only group. Performing POCUS followed by RADUS did not significantly delay the treatment among HPS patients.Conclusions: Point-of-care ultrasound is accurate and useful for diagnosing HPS and improved the ED patient flow by reducing EDLOS and door-to-disposition time in non-HPS patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department

et al. 2021

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“…The relevance of this work is stated from the following: high frequency of occurrence (4.49-20.2%); complex clinical course; absence of a standard clinical strand in the diagnosis of CFCS and its subsequent therapy; progressive mortality rate (Zainulabidov, Razumovsky, Khavkin, 2020;Meister et al, 2020). One of the main clinical manifestations of CFCS is abdominal pain syndrome, manifested as a result of its compression.…”

Section: Introductionmentioning

confidence: 99%

Clinic, diagnosis and treatment of dunbar syndrome in children

Андреев¹,

Krasnov

Никитина³

2022

ijhs

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Aim: To determine the clinical, diagnostic and therapeutic features of Dunbar syndrome in children. Methods: Scientific work was carried out based on the "Republican Children's Clinical Hospital" and the "City Children's Clinical Hospital", Cheboksary. The basis of this study was a survey of 200 children with celiac artery compression syndrome. The results obtained in the course of the work were analyzed on the basis of the Department of Children's Diseases of the I.N. Ulianov Chuvash State University. In addition to routine diagnostic methods, Instrumental methods have been adopted: ultrasound Doppler scanning (Hitachi Vision Avius, Japan), CT angiography (SOMATOM Emotion, SIEMENS (China), Revolution EVO, GE (Russia)) and Magnetic resonance angiography (Optima MR450w 1.5, USA). The duration of the study is short (after surgery) and long-term (up to 2 years). Results: Dunbar syndrome is more often observed in girls, which in 75% of cases is accompanied by signs of chronic abdominal ischemia. Significant and prolonged stenosis of the celiac artery can cause the development of a number of complications (pancreatic-duodenal artery aneurysms, etc.).

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“…pylorospasm as a true pyloric stenosis. Having an overly distended stomach can alter the position of the pylorus which can lead to it looking atypical and an empty stomach can sometimes make it difficult to see stomach contents pass through the pyloric canal24 leading to false-positive ultrasound evaluations. Experience can help mitigate these pitfalls and prevent misinterpretation of findings, particularly in the context of false-negative evaluations which could delaying transfer and treatment as well as false-positive studies leading to unnecessary transfer of an infant and their family.…”

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confidence: 99%

An audit of inter‐hospital transfers of children with abdominal pain and their associated medical imaging findings

2021

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Introduction: Ultrasound is a common first-line examination in acute abdominal pain in children. In rural and regional areas, ultrasound is an important factor in decisions to transfer paediatric patients for tertiary care. Transfers can be over a considerable distance, by road and air, and at great cost. This audit reviewed ultrasound findings in children transferred to an Australian paediatric hospital for acute abdominal pain.Methods: Children transferred for acute abdominal pain between July 2018 and June 2019 was identified. Imaging findings at the transferring and receiving facility were reviewed, along with the patient's electronic medical record. Suspected and final diagnoses were recorded, and the accuracy of imaging evaluated.Results: There were 172 transfers identified, mean age was 6 years 1 month, 66.3% were boys. Mean transfer distance was 55.4 km. The majority were suspected acute appendicitis (63.9%), followed by intussusception (20.3%), and hypertrophic pyloric stenosis (14.5%). The majority of suspected diagnoses were ultimately false positives including pyloric stenosis, 52.0%; appendicitis, 50.9% and ileo-colic intussusception, 74.3% of cases negative. Conclusion:Improved diagnostic accuracy in evaluating causes of acute paediatric abdominal pain with ultrasound, particularly appendicitis, pyloric stenosis, and intussusception is required. Targeted education and clinical support mechanisms may reduce potentially unnecessary inter-hospital transfers and their considerable associated costs.

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Pediatric emergency gastrointestinal ultrasonography: pearls & pitfalls

Cited by 8 publications

References 59 publications

Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department

Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department

Clinic, diagnosis and treatment of dunbar syndrome in children

An audit of inter‐hospital transfers of children with abdominal pain and their associated medical imaging findings

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