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Intussusception – How Accurate Is History, Exam, X-ray, Ultrasound?

October 21, 2020

Written by Clay Smith

Spoon Feed
History, exam, and x-ray were not accurate predictors of intussusception, but POCUS was very accurate. If you suspect it, get an ultrasound.

Why does this matter?
How helpful is history, exam, and imaging for intussusception? If patients lack abdominal pain or bloody stools, are they in the clear? If the x-ray is normal, do we need an ultrasound as well? Hopefully, this study will help.

Why couldn’t this be called donut-bowel instead of intussusception
This was a systematic review and meta-analysis of 13 largely retrospective studies, not all of which covered each aspect of history, exam, etc. Key findings are summarized in these tables.

From cited article
From cited article
From cited article

What do these numbers mean?

  • History and exam are not accurate to rule in or out intussusception but help suggest more workup is needed.

  • It also can’t be ruled out with an x-ray, although a negative x-ray may nudge the post-test probability lower.

  • This study focused solely on POCUS done in the ED, which was very good (in the right hands) at ruling in and out intussusception.

  • The bottom line is that a child with vomiting and abdominal pain may have intussusception. Concern is heightened even more if they have history of rectal bleeding, distention, palpable mass, gross blood on exam, or guaiac positive stool. In such patients, an x-ray is not very helpful. It makes more sense to go directly to ultrasound, though some centers include both x-ray and ultrasound by protocol.

Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception: A Systematic Review and Meta-analysis. Pediatr Emerg Care. 2020 Sep 15. doi: 10.1097/PEC.0000000000002224. Online ahead of print.

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What are your thoughts?