Dataset Information

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

ABSTRACT:

Introduction

Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception by emergency physicians (EP).

Methods

We conducted a systematic search on PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, as well as conference abstracts, and assessed bibliographies of selected articles for all studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. We dual extracted data into a predefined worksheet and performed quality analysis with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed.

Results

Six studies (n = 1303 children) met our inclusion criteria. Overall, 11.9% of children had intussusception. POCUS was 94.9% (95% confidence interval [CI], 89.9% to 97.5%) sensitive and 99.1% (95% CI, 94.7% to 99.8%) specific with a likelihood ratio (LR)+ of 105 (95% CI, 18 to 625) and a LR- of 0.05 (95% CI, 0.03 to 0.10).

Conclusion

POCUS by EPs is highly sensitive and specific for the identification of intussusception for children presenting to the emergency department.

SUBMITTER: Lin-Martore M

PROVIDER: S-EPMC7390574 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

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

Lin-Martore Margaret M Kornblith Aaron E AE Kohn Michael A MA Gottlieb Michael M

The western journal of emergency medicine 20200702 4

<h4>Introduction</h4>Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for childr ...[more]

PMID: 32726276

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Project description:ObjectivesPoint-of-care ultrasound (POCUS) may facilitate the diagnosis and management of children for various conditions. Integration of POCUS into clinical care requires hands-on training; however, providers may be reluctant to perform educational ultrasounds to improve their skills, as it is a procedure without direct clinical benefit to the patient and due to concerns that it may lower a family's overall satisfaction. We sought to evaluate whether the use of POCUS changed overall patient/caregiver satisfaction in a pediatric emergency department (ED) visit.MethodsWe performed a prospective cohort study of children presenting to a single children's hospital ED. We evaluated overall satisfaction for three groups: 1) children undergoing POCUS for educational purposes, 2) children undergoing POCUS for a specific diagnostic indication, and 3) controls who did not receive POCUS. Overall satisfaction was measured using a 100-point visual analog scale (VAS). We performed a noninferiority test between patients receiving POCUS and controls using a delta of 10 points to determine significance. We also examined satisfaction among patients receiving diagnostic ultrasound and sought to determine patient/caregiver satisfaction with specific elements of the POCUS experience.ResultsWe surveyed 159 patients who presented between April 2016 and August 2016 (53 in each group). The three groups did not differ with respect to patient age, sex, or Emergency Severity Index level. The median VAS scores for both the educational and the diagnostic POCUS groups (94 and 94, respectively) were not inferior to the VAS score for the control group (91) with a median (95% confidence interval [CI]) difference of 3.0 (-2.2 to 8.2) for educational and control groups and 3.0 (-1.6 to 7.6) for diagnostic and control groups. No patients/caregivers in the educational POCUS group would refuse an educational ultrasound during a future medical encounter.ConclusionEducational POCUS does not decrease patient/caregiver satisfaction among children presenting to the ED.

Project description:BackgroundDyspnea is one of the common symptoms patients present to the emergency department (ED). The broad spectrum of differentials often requires laboratory and radiological testing in addition to clinical evaluation, causing unnecessary delay. Point of care ultrasound (PoCUS) has shown promising results in accurately diagnosing patients with dyspnea, thus, becoming a popular tool in ED while saving time and maintaining safety standards. Our study aimed to determine the utilization of point of care ultrasound in patients with acute dyspnea as an initial diagnostic tool in our settings.MethodologyThe study was conducted at the emergency department of a tertiary healthcare center in Northern India. Adult patients presenting with acute dyspnea were prospectively enrolled. They were clinically evaluated and necessarily investigated, and a provisional diagnosis was made. Another EP, trained in PoCUS, performed the scan, blinded to the laboratory investigations (not the clinical parameters), and made a PoCUS diagnosis. Our gold standard was the final composite diagnosis made by two Emergency Medicine consultants (who had access to all investigations). Accuracy and concordance of the ultrasound diagnosis to the final composite diagnosis were calculated. The time to formulate a PoCUS diagnosis and final composite diagnosis was compared.ResultsTwo hundred thirty-seven patients were enrolled. The PoCUS and final composite diagnosis showed good concordance (κ = 0.668). PoCUS showed a high sensitivity for acute pulmonary edema, pleural effusion, pneumothorax, pneumonia, pericardial effusion, and low sensitivity for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute respiratory distress syndrome (ARDS)/acute lung injury (ALI). High overall specificity was seen. A high positive predictive value for all except left ventricular dysfunction, pericardial effusion, non-cardiopulmonary causes of dyspnea, and a low negative predictive value was seen for pneumonia. The median time to make a PoCUS diagnosis was 16 (5-264) min compared to the 170 (8-1346) min taken for the final composite diagnosis. Thus, time was significantly lower for PoCUS diagnosis (p value <0.001).ConclusionBy combining the overall accuracy of PoCUS, the concordance with the final composite diagnosis, and the statistically significant reduction in time taken to formulate the diagnosis, PoCUS shows immense promise as an initial diagnostic tool that may expedite the decision-making in ED for patients' prompt management and disposition with reliable accuracy.

Project description:Aim: Intussusception, the most common abdominal emergency in early childhood, is frequently misdiagnosed at initial presentation. The effect of using point-of-care ultrasonography (POCUS) by emergency medicine physicians on pediatric intussusception misdiagnosis rate remains unclear. Here, we summarize outcomes and misdiagnoses before and after training junior and senior physicians on using POCUS for diagnosing intussusception and compared their performance levels. Materials and Methods: This observational cohort analysis included patients with suspected intussusception who visited a pediatric emergency department (ED) between January 2017 and December 2019. All enrolled patients were evaluated by junior (<10-year experience) or senior attending physicians. Misdiagnosis was defined as a finding of negative air reduction or confirmation of diagnosis on ED revisit or admission. The misdiagnosis rates and outcomes before and after POCUS training for intussusception diagnosis were evaluated and performance of the junior and senior physicians was compared. Results: Of the 167 enrolled patients, 130 were confirmed to have intussusception by air reduction. Misdiagnosis rate was significantly lower in the post-training patient group after training than in the pre-training patient group (43.7 vs. 12.7%, P < 0.001). After training, fewer misdiagnoses were made by the junior (59.1 vs. 25.9%, P = 0.003) and senior (31.7 vs. 0%, P < 0.001) physicians. In the post-training patient group, the door-to-reduction time and rate of ultrasonography consultation with an expert also decreased significantly (118.2 ± 124.5 vs. 198 ± 250.2 min, P = 0.006). Abdominal pain (80.9%) was the most common symptom of intussusception, followed by vomiting (58.3%), fever (17.8%), bloody stool (15.4%), and diarrhea (14.2%). Even after training, the presenting symptoms of intussusception often leading junior physicians to misdiagnosis were diarrhea and fever. Conclusions: A brief POCUS training leads to decreased misdiagnosis rates in both the senior and junior physicians. Junior physicians should increase their awareness regarding diarrhea and fever being the presenting symptoms of intussusception, particularly in early childhood. Combining clinical judgment and POCUS results forms the core principle of the evaluation of children with intussusception.

Dataset Information

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

Introduction

Methods

Results

Conclusion

Publications

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

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