Bhisitkul D M, Listernick R, Shkolnik A, Donaldson J S, Henricks B D, Feinstein K A, Fernbach S K
Division of General Academic and Emergency Pediatrics, Children's Memorial Hospital, Chicago, Illinois 60614.
J Pediatr. 1992 Aug;121(2):182-6. doi: 10.1016/s0022-3476(05)81185-0.
Sixty-five consecutive patients seen in a pediatric emergency department, in whom the diagnosis of intussusception was considered, had an ultrasound examination of the abdomen before a barium enema. The mean age of the patients was 1.7 years (range 2 weeks to 5 years). Intussusception was detected by ultrasonography in all 20 cases proved by barium enema. There were three false-positive ultrasound results (sensitivity = 100%, confidence interval (Cl) = 86% to 100%; specificity = 93%, Cl = 86% to 96%). Normal findings on ultrasonography correlated with a negative barium enema results in 42 of 42 cases (negative predictive value = 100%, Cl = 94% to 100%). No intussusception was missed by ultrasonography. To determine which patients would most benefit from ultrasonography, we divided patients into either a high-risk group (81% with intussusception) or a low-risk group (14% with intussusception) on the basis of clinical symptoms (p less than 0.01). If each high-risk child had a barium enema and each low-risk child had an ultrasound study as their initial diagnostic test, 89% of the patients in this study would have undergone only one examination. We conclude that ultrasonography can be used as a rapid, sensitive screening procedure in the diagnosis or exclusion of childhood intussusception. Children considered at low risk of having intussusception on the basis of clinical symptoms should initially have an ultrasound examination; patients at high risk should have an immediate barium enema.
在一家儿科急诊科连续就诊的65例疑似肠套叠的患者，在进行钡剂灌肠前接受了腹部超声检查。患者的平均年龄为1.7岁（范围为2周龄至5岁）。在所有20例经钡剂灌肠证实的病例中，超声均检测出肠套叠。超声检查有3例假阳性结果（敏感性 = 100%，置信区间(Cl)=86%至100%；特异性 = 93%，Cl = 86%至96%）。42例超声检查结果正常的患者，钡剂灌肠结果均为阴性（阴性预测值 = 100%，Cl = 94%至100%）。超声检查未漏诊任何一例肠套叠。为了确定哪些患者能从超声检查中获益最大，我们根据临床症状将患者分为高危组（81%患有肠套叠）或低危组（14%患有肠套叠）（P<0.01）。如果每个高危儿童以钡剂灌肠作为初始诊断检查，每个低危儿童以超声检查作为初始诊断检查，那么本研究中89%的患者仅需接受一项检查。我们得出结论，超声检查可作为诊断或排除儿童肠套叠的快速、敏感的筛查方法。根据临床症状被认为肠套叠风险较低的儿童应首先进行超声检查；高危患者应立即进行钡剂灌肠。
