October 19, 2011 (Boston, Massachusetts) — Ultrasound is superior to 2-view abdominal radiography to rule out or confirm a diagnosis of ileo-intussusception in children, according to new research presented here at the American Academy of Pediatrics (AAP) 2011 National Conference and Exhibition.
"Ileo-colic intussusception is a common surgical emergency in young children who come into the emergency department with abdominal pain, and we often have to image these patients," senior author Rakesh Mistry, MD, from the Children's Hospital of Philadelphia in Pennsylvania, told Medscape Medical News.
Some recent studies suggest that intussusception can be easily ruled out using 3-view abdominal radiography, Dr. Mistry said. "However, when you look at what's commonly done across the country, it's usually 2-view films, not 3-view films, that are the standard practice for the evaluation of abdominal pain when people order radiographs."
Dr. Mistry and his team did a retrospective chart review of 286 children aged 3 months to 3 years who had both 2-view radiography and an ultrasound performed in their emergency department for suspected intussusception between 2007 and 2009.
The patients' mean age was 16 months; 62% of patients were male, and 44% were African American. Of these patients, 61 (21.3%) had confirmed intussusception. Physical examination findings showed a significant positive association with abdominal tenderness (38.6% vs 20.0%; P = .003), grossly bloody stool (36.8% vs 8.2%; P = .001), and guaiac-positive stool (64.7% vs 30.4%; P = .009).
The researchers found that 2-view abdominal radiography had a greater false-positive rate, 10.5%, compared with 2.8% for ultrasound, and a greater false-negative rate, 8.0%, compared with 0.3% for ultrasound.
Ultrasound also exhibited superior positive and negative predictive values and likelihood ratios compared with 2-view radiography.
"Our conclusion is essentially that ultrasound should be used primarily when there is a suspicion for intussusception or if you wish to exclude intussusception in your patient, and that plain film itself is not reliable enough to rule out these possibilities," Dr. Mistry said. "If you use 2-view, there is a possibility that you could be making some clinical decisions that may not be prudent if you base them solely on the x-ray."
He added, "There is a possibility that 3-view would be better, but it's not routine practice in most places. Also the 3-views are not always agreed upon."
Lei Chen, MD, from Yale University School of Medicine in New Haven, Connecticut, was asked to comment on this study by Medscape Medical News.
According to Dr. Chen, ultrasound's superior sensitivity and specificity are well established.
"The use of plain films to rule out intussusception would be useful but the sensitivity of the test is too low, as reported by the research presented here in Dr. Mistry's study, to be used in this way," Dr. Chen said.
"As ultrasound becomes more widely available, the next research should look at how good pediatric emergency medicine physician-performed ultrasound is," he added.
Dr. Mistry and Dr. Chen have disclosed no relevant financial relationships.
American Academy of Pediatrics (APP) 2011 National Conference and Exhibition. Presented October 14, 2011.
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Cite this: Ultrasound Best for Diagnosing Intussusception - Medscape - Oct 19, 2011.