Evidence-Based Diagnostic Test Accuracy of History, Physical Examination, and Imaging for Intussusception A Systematic Review and Meta-analysis

Jeffrey Hom, Carl Kaplan, Susan Fowler, Catherine Messina, Latha Chandran, Sergey Kunkov

Research output: Contribution to journalReview articlepeer-review

Abstract

Introduction: Intussusception is the most common cause of pediatric small bowel obstruction. Timely and accurate diagnosis may reduce the risk of bowel ischemia. We quantified the diagnostic test accuracy of history, physical examination, abdominal radiographs, and point-of-care ultrasound. Method: We conducted a systematic review for diagnostic test accuracy of history, physical examination, and imaging concerning for intussusception. Our literature search was completed in June 2019. Databases included Medline via Ovid, Embase, Scopus, and Wiley Cochrane Library.We conducted a second review of the literature up to June 2019 for any additional studies. Inclusion criteria were younger than 18 years and presenting to the emergency department for abdominal complaints, consistent with intussusception. We performed data analysis using mada, version 0.5.8. We conducted univariate and bivariate analysis (random effects model) with DerSimonian-Laird and Reitsma model, respectively. QUADAS-2 was used for bias assessment. Results: The literature search identified 2639 articles, of which 13 primary studies met our inclusion criteria. Abdominal pain, vomiting, and bloody stools had positive likelihood ratios LR(+) between 1 and 2, whereas the negative likelihood ratio, LR(-), ranged between 0.4 and 0.8. Abnormal abdominal radiograph had LR(+) of 2.5 and LR(-) of 0.20, whereas its diagnostic odds ratio was 13. Lastly, point-of-care ultrasound had LR(+) of 19.7 and LR(-) of 0.10. The diagnostic odds ratio was 213. Conclusions: History and physical examination had low diagnostic test accuracy. Abdominal radiographs had low diagnostic test accuracy, despite moderate discriminatory characteristics. Point-of-care ultrasound had the highest diagnostic test accuracy to rule in or rule out intussusception.

Original languageEnglish (US)
Pages (from-to)e225-e230
JournalPediatric Emergency Care
Volume38
Issue number1
DOIs
StatePublished - Jan 1 2022
Externally publishedYes

Keywords

  • Diagnostic test accuracy
  • Evidence-based medicine
  • History
  • Intussusception
  • Physical examination
  • Point-of-care ultrasound
  • Radiographs

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

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