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Investigators from multiple institutions conducted a prospective study to assess the accuracy of point of care ultrasounds (POCUS), performed by trained pediatric emergency physicians, for the diagnosis of intussusception in young children. Study patients were children 3 months to 6 years old, presenting with clinical suspicion of intussusception to 17 pediatric EDs in North and Central America, Europe, and Australia between 2018 and 2020. POCUS were performed by pediatric emergency physicians who had completed an ultrasound fellowship, had a registered diagnostic medical sonographer designation, or had previously completed ≥20 abdominal POCUS examinations. A radiology- performed ultrasound (RADUS) also was obtained on study patients. POCUS studies were considered positive for intussusception if a target-shaped mass ≥2.0 cm was identified, and/or if the pediatric emergency physician determined that there was an intussusception that required intervention. For RADUS examinations, the diagnosis of intussusception was based on the attending radiologist’s interpretation. The primary outcome was clinically important intussusception, defined as an intussusception requiring radiographic (ie, enema) or surgical reduction within 7 days of the index ED visit.
The accuracy of POCUS (defined as true positives plus true negatives divided by total number of examinations) and RADUS were determined, as well as the sensitivity and specificity of both in predicting intussusception. The difference in accuracy between RADUS and POCUS was assessed with a mixed-effects model, with the physician conducting the POCUS exam included as a random effects term. A priori, it was determined that if the upper limits of the 95% CI of the difference was <4 percentage points, POCUS was non-inferior to RADUS as a method to diagnose intussusception.
Data were analyzed on 256 children with a median age of 21.1 months. The most common chief complaints among these patients were abdominal pain (82.8%) and fussiness (80.5%). A total of 58 patients (22.7%) had clinically important intussusceptions. POCUS examinations were conducted by 35 pediatric emergency physicians. The accuracy of POCUS examinations in diagnosing intussusception was 97.7% (95% CI, 94.9, 99.0), with a sensitivity of 96.6% (95% CI, 87.2, 99.1) and a specificity of 98.0% (95% CI, 94.7, 99.2). For RADUS, the accuracy was 99.3% (95% CI, 96.8, 99.9), sensitivity 98.3% (95% CI, 88.7, 99.8), and specificity 99.5% (95% CI, 96.5, 99.9). The difference in accuracy between POCUS and RADUS examinations was 1.5 percentage points (95% CI, -0.6, 3.6), thus meeting the criterion for non- inferiority of POCUS compared to RADUS for diagnosing intussusception.
The authors conclude that the accuracy of POCUS performed by experienced clinicians was non-inferior to that of RADUS in diagnosing intussusception in young children.
Dr Bechtel has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Intussusception is...
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