Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia

Abstract

Objective To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available. Methods Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants aged < 2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged < 2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne). Findings In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%). Conclusion The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely. Voir page 574 le résumé en français. En la página 574 figura un resumen en español. IntroductionThe withdrawal of the first rotavirus vacc c cine to be licensed in the United States (RotaShield, Wyeth-Lederle Vaccines, Philadelphia, PA, United States), due to an unexpected association with intusc c susception, resulted in a major setback in the effort to reduce the global burden of rotavirus gastroenteritis.1-3 Although the risk of intussusception following imc c munization with RotaShield is low, it has posed a major challenge to the future development of a safe and effective vacc c cine.2 Largecscale clinical trials are now required to detect a risk of intussusception of < 1 in 10 000. [4][5][6] Baseline intussuscepc c tion surveillance is needed in sites where trials of rotavirus vaccines are planned, and postclicensure intussusception surc c veillance may also be required by some licensing agencies. Intussusception is the invagination of the bowel by a more proximal segment. The intussusception can be propelled disc c tally by peristalsis, resulting in intestinal obstruction and vascular compromise of the intestine. Prompt identification and reduction by air enema or hydrostatic enema or by surgery is vital to minimize the morbidity and mortality that may be associat...

Rotavirus infection and intussusception in Tunisian children: implications for use of attenuated rotavirus vaccines

“…Nicolas et al [38] found evidence of a viral infection in 50% of patients with intussusception. Virus infections that have been commonly linked with intussusception were mostly because of adenovirus [39,40] but also to human herpes virus-6, human herpes virus-7, Epstein-Barr virus, and cytomegalovirus [1,33]. Between 1978 and 1982, 3 virologic studies of intussusception have reported the identification of rotavirus infection in children with intussusception [32,38,41].…”

Incidence of intussusception in Singaporean children aged less than 2 years: a hospital-based prospective study

“…A review of published literature between 1966 and 2001 by the World Health Organization on the worldwide IS incidence also showed that the incidence of IS was higher in children aged < 1 year than in children aged < 2 years [2]. Furthermore, the peak incidence of IS was observed between 4–8 months of age, with highest number of cases reported at six months of age.…”

“…It occurs when one segment of bowel invaginates into the distal bowel, resulting in venous congestion and bowel wall edema [2]. Early diagnosis of IS is done using ultrasonography and/or air/hydrostatic enema.…”

“…Early diagnosis of IS is done using ultrasonography and/or air/hydrostatic enema. Air/hydrostatic enema is also used for the treatment of IS, in addition to surgical reduction of IS [3]. IS cases are most commonly observed in young children within the first year of life and are rare in children aged < 6 weeks, older children and adults [2].…”

Invagination intestinale avec boudin prolabé par l’anus chez l’enfant

“…La triade classique associe des vomissements, des douleurs abdominales paroxystiques et des rectorragies qui sont habituellement tardives et considérées comme un signe de gravité [2][3][4]8]. La mise en évidence du boudin d'invagination est une aide pour le diagnostic mais il est rarement palpable [3,8,9]. L'échographie abdominale est l'examen clé pour confirmer le diagnostic [2,3,9].…”