Henderson Alicia Anne, Anupindi Sudha A, Servaes Sabah, Markowitz Richard I, Aronson Paul L, McLoughlin Robert J, Mistry Rakesh D
Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Pediatr Emerg Care. 2013 Feb;29(2):145-50. doi: 10.1097/PEC.0b013e3182808af7.
The clinical presentation of intussusception is variable; therefore, screening with either abdominal radiography (AXR) or abdominal ultrasound (US) is often used, although the optimal method is not known.
This study aimed to compare the utility of AXR with that of the US in children with suspected intussusception.
Retrospective cohort of children age 3 months to 3 years presenting to a pediatric emergency department (ED) between 2007 and 2009. Inclusion criteria were as follows: (1) presentation to the ED for suspected intussusception and (2) both 2-view AXR and US performed during the ED visit. An AXR was deemed negative for intussusception if air was visualized in the ascending colon on 2 views and transverse colon on the supine view; US results were obtained from the radiologist report at the time of presentation. Criterion standard measures for intussusception were contrast enema, operative report, or follow-up.
A total of 286 children were included, with mean (SD) age 16.1 (9.1) months; 62.2% were male, and 43.7% were African American. Intussusception was present in 61 subjects (21.3%). Abdominal radiography had sensitivity of 62.3% (95% confidence interval [CI], 50.1%-74.5%) and specificity of 86.7% (95% CI, 82.2%-91.1%), whereas US had a sensitivity of 98.4% (95% CI, 95.2%-100.0%) and specificity of 96.4% (95% CI, 94.0%-98.9%). Ultrasound had a greater negative predictive value (99.5%; 95% CI, 98.6%-100.4%) compared with AXR (89.4%; 95% CI, 85.4%-93.5%). Abdominal radiography had a greater false-positive rate (13.3% vs 3.6%) and greater false-negative rate (37.8% vs 1.6%), compared with US.
Ultrasound is superior to AXR as a screening method for establishing and excluding the diagnosis of intussusception. The poor test characteristics of 2-view AXR suggest that it should not be used as a primary screening method in cases of suspected intussusception.
肠套叠的临床表现具有多样性；因此，尽管最佳方法尚不清楚，但腹部X线平片（AXR）或腹部超声（US）筛查常被采用。
本研究旨在比较AXR与US在疑似肠套叠儿童中的应用价值。
对2007年至2009年期间到儿科急诊科就诊的3个月至3岁儿童进行回顾性队列研究。纳入标准如下：（1）因疑似肠套叠到急诊科就诊；（2）在急诊科就诊期间同时进行了双视图AXR和US检查。如果在两个视图上均可见升结肠内有气体且仰卧位视图上可见横结肠内有气体，则AXR被认为肠套叠阴性；US结果来自就诊时放射科医生的报告。肠套叠的标准测量方法为对比灌肠、手术报告或随访。
共纳入286名儿童，平均（标准差）年龄为16.1（9.1）个月；62.2%为男性，43.7%为非裔美国人。61名受试者（21.3%）存在肠套叠。腹部X线平片的敏感性为62.3%（95%置信区间[CI]，50.1%-74.5%），特异性为86.7%（9
