Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
BMC Pediatr. 2020 Apr 13;20(1):155. doi: 10.1186/s12887-020-02060-6.
This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage.
This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥ 2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as "negative" or "suspicious," and a radiologist performed confirmatory ultrasound in "suspicious" cases.
We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 "suspicious" cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 h, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain (P < 0.001), but less vomiting (P = 0.001); the other clinical features showed no intergroup differences.
POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.
本研究旨在验证儿科急诊医生进行即时超声（POCUS）检测肠套叠的早期检测的有效性。
本回顾性研究纳入了 2016 年 12 月至 2018 年 2 月期间在儿科急诊就诊的 1 个月至 6 岁有疑似肠套叠的儿童。POCUS 检查的标准设定为更广泛的标准：表现为间歇性腹痛/烦躁不安或血便，或非特异性腹痛/烦躁不安、腹部肿块/膨隆、呕吐或嗜睡中≥2 个症状。对 POCUS 结果进行解释并分类为“阴性”或“可疑”，对“可疑”病例由放射科医生进行确认性超声检查。
我们分析了 549 例患者的 575 次 POCUS 扫描（平均年龄 25.5 个月）。在 92 例“可疑”病例中（16.0%），70 例（12.2%）被确认为肠套叠。POCUS 的敏感度为 100%，特异度为 95.6%，准确率为 97.8%。经证实的肠套叠患者主要在早期诊断，症状持续时间平均为 11.7 小时，大多数患者（97.1%）通过空气灌肠复位成功治疗。与非肠套叠组相比，肠套叠组间歇性腹痛更多（P < 0.001），但呕吐更少（P = 0.001）；其他临床特征两组间无差异。
儿科急诊医生使用更广泛标准进行 POCUS 检查可能有助于早期检测肠套叠，肠套叠可能表现为隐匿性临床症状。
