Point-of-Care Ultrasound Could Streamline the Emergency Department Workflow of Clinically Nonspecific Intussusception

Abstract

Objectives The aim of this study was to evaluate whether point-of-care ultrasound (POCUS) for intussusception screening streamlines the workflow of clinically nonspecific intussusception (CNI), an intussusception presenting with only 1 manifestation of the classic triad, and/or vomiting. Methods We reviewed 274 consecutive children with intussusception, aged 6 years or younger, who visited a tertiary care hospital emergency department between May 2012 and April 2016. This period was dichotomized by May 2014 (the “PRE” and “POST” groups), starting point of implementation of the POCUS protocol for intussusception screening. All children with CNI who had positive results on or forwent POCUS underwent radiologist-performed ultrasound (US). We measured and compared emergency department length of stay (EDLOS), the sum of door-to-reduction and observation times, and the frequency of POCUS and positive US results between the 2 groups. Results Of 160 children with CNI, 93 visited the emergency department since May 2014. The POST group showed a shorter median EDLOS (856 vs 630 minutes, P < 0.001), door-to-reduction time (137 vs 111 minutes, P = 0.002), and observation time (700 vs 532 minutes, P < 0.001). The POST group had a higher frequency of POCUS (12% vs 60%, P < 0.001) with positive US results (33% vs 59%, P < 0.001). The PRE group had a higher frequency of severe bowel edema (16% vs 1%, P < 0.001). No significant differences were found in the severity, recurrence, admission, and surgery. One child had a false-negative result on POCUS. Conclusions Point-of-care ultrasound could streamline the workflow of CNI via decrease in EDLOS and unnecessary referrals for US.

Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis

“…In fact, one study found that the institution of a POCUS protocol for intussusception reduced length of stay by over 200 minutes and shortened the door-to-reduction time by 26 minutes. 24 A recent systematic review and meta-analysis by Tsou et al 23 evaluated combined radiologic ultrasound and POCUS, demonstrating similar sensitivity and specificity to our study. However, our study differs in that we excluded radiology ultrasound and focused specifically on POCUS for intussusception.…”

Application of Point-of-Care Ultrasound for Family Medicine Physicians for Abdominopelvic and Soft Tissue Assessment

“…POCUS reduces patient length of stay in the emergency department [38]. While exact numbers vary across emergency departments, reduction in length of stay ranged from 26 minutes to two hours [39,40]. This reduction in the length of stay is most significant during evening, overnight, and weekend visits [38,41].…”

Point-of-care ultrasound may be useful for detecting pediatric intussusception at an early stage

“…In contrast, ultrasound can accurately diagnose intussusception with a high accuracy of 97.9% sensitivity and 97.8% specificity, and therefore is recommended as the diagnostic modality of choice [7]. However, requesting radiologist-performed ultrasound (RADUS) in all clinically suspected cases might be time-consuming and inefficient for the ED workflow [8].…”

“…Several studies have suggested that point-of-care ultrasound (POCUS) performed by pediatric emergency physicians could be a practical measure [8][9][10]. POCUS for detecting intussusception is relatively easy to learn and readily available in the ED [10][11][12].…”