Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

Abstract

Background: 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.Methods: This 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.Results: We 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 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the nonintussusception 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.Conclusion: POCUS 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. POCUS:Point-of-care ultrasound RADUS: Radiologist-performed ultrasound Declarations Ethics approval and consent to participate: The institutional review board of Asan Medical Center approved this study and waived the requirement for informed consent (study number 2018-0418).

Current diagnosis and image-guided reduction for intussusception in children

“…Typical ultrasound findings of intussusception include the target sign (transverse view) or pseudo-kidney sign (longitudinal view), corresponding to the intussusceptum and surrounding hyperechoic mesenteric fat within the intussuscipiens (Figure 2) 1,30) . Several studies have reported promising results for point-of-care ultrasound (POCUS) performed by trained pediatric emergency physicians with excellent sensitivity (100%) and A c c e p t e d A r t i c l e good specificity (94-95%) (Table 2) 35,36) . POCUS might be helpful in screening for suspected intussusception and ruling out non-intussusception in children early at the bedside, especially in cases of atypical or vague clinical presentation [35][36][37][38][39] .…”

“…Several studies have reported promising results for point-of-care ultrasound (POCUS) performed by trained pediatric emergency physicians with excellent sensitivity (100%) and A c c e p t e d A r t i c l e good specificity (94-95%) (Table 2) 35,36) . POCUS might be helpful in screening for suspected intussusception and ruling out non-intussusception in children early at the bedside, especially in cases of atypical or vague clinical presentation [35][36][37][38][39] .…”

“…In cases of multiple recurrence, meticulous evaluation should be performed to identify possible pathological lead points. 36,38,39,73) POCUS is highly sensitive…”