Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests
2Department of Pediatric Emergency Medicine, Maimonides Medical Center, ארצות הברית
3Department of Pediatric Emergency Medicine, The Hospital for Sick Children, קנדה
4Department of Emergency Medicine, Hospital National De Ninos, קוסטה ריקה
5Department of Surgery, Hospital National De Ninos, קוסטה ריקה
6Department of Emergency Medicine, Atrium Health's Carolines Medical Center, ארצות הברית
7Department of Emergency Medicine, Schneider Children's Medical Center, ישראל
8Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, ארצות הברית
9Department of Emergency Medicine, Sutter Medical Center Sacramento, ארצות הברית
10Department of Pediatric Emergency Medicine, Gold Coast University Hospital, אוסטרליה
11Department of Pediatric Emergency Medicine, University of Minnesota Masonic Childrens' Hospital, ארצות הברית
12Department of Pediatric Emergency Medicine, Children's Healthcare Atlanta and Emory University, ארצות הברית
13Department of Pediatric Emergency Medicine, The Edmond and Lily Safra Children's Hospital, ישראל
14Department of Pediatrics, University of California, ארצות הברית
15The Depratment of Pediatric and Emergency Medicine, University of North Carolina, ארצות הברית
16The Depratment of Emergency Medicine and Pediatrics, University of California, ארצות הברית
17Department of Pediatric Emergency Medicine, Hospital Infantil Ciudad Juarez, מקסיקו
18Department of Pediatric Emergency Medicine, Children's National Hospital, ארצות הברית
19The Department of Research and Sponsored Programs, Children's Minnesota, ארצות הברית
20Department of Emergency Medicine, Newark Beth Israel Medical Center, ארצות הברית
Objective: To determine the diagnostic accuracy of point-of-care ultrasound (POCUS) performed by ultrasound trained pediatric emergency physicians compared to radiology-performed ultrasound (RADUS) for detection of clinically important intussusception, defined as intussusception requiring radiographic or surgical reduction.
Methods: Multicenter, noninferiority, observational study among a convenience sample of children aged 3 months to 6 years treated in emergency departments across North and Central America, Europe, Australia and Israel. The primary outcome was diagnostic accuracy of POCUS and RADUS with respect to clinically important intussusception. Secondary outcomes included agreement between POCUS and RADUS for identification of secondary sonographic findings.
Results
The analysis included 256 children across 17 sites (35 sonologists). Of the 256 children, 58 (22.7%) had clinically important intussusception. POCUS identified 60 (23.4%) children with clinically important intussusception. The diagnostic accuracy of POCUS was 97.7% (95% confidence interval [CI] 94.9% to 99.0%), compared to 99.3% (95% CI 96.8% to 99.9%) for RADUS. The absolute difference between the accuracy of RADUS and that of POCUS was 1.5 percentage points (95% CI −0.6 to 3.6). Sensitivity for POCUS was 96.6% (95% CI 87.2% to 99.1%), and specificity was 98.0% (95% CI 94.7% to 99.2%).
Conclusion: POCUS has high diagnostic accuracy for identification of clinically important intussusception and requires minimal time compared to RADUS. Our results suggest that POCUS may be used as a screening tool for children with suspected intussusception and may increase patient throughput in the ED. Given the limitations of convenience sampling and spectrum bias, a larger randomized controlled trial is warranted.