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Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis

      Abstract

      Objective

      It is unclear whether point-of-care ultrasound (POCUS) by emergency medicine physicians is as accurate as radiology-performed ultrasound (RADUS). We aim to summarize the diagnostic accuracy of ultrasonography for intussusception and to compare the performance between POCUS and RADUS.

      Methods

      Databases were searched from inception through February 2018 using pre-defined index terms. Peer-reviewed primary studies that investigated the diagnostic accuracy of ultrasound for intussusception in children were included. The study is reported using Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA). Meta-analysis of the diagnostic accuracy of ultrasound for intussusception was conducted using the random-effects bivariate model. Subgroup analysis (POCUS vs RADUS) was also performed. Meta-regression was utilized to determine if the diagnostic accuracy between POCUS and RADUS was significantly different.

      Results

      Thirty studies (n = 5249) were included in the meta-analysis. Ultrasonography for intussusception has a sensitivity: 0.98 (95% CI: 0.96–0.98), specificity: 0.98 (95% CI: 0.95–0.99), positive likelihood ratio: 43.8 (95% CI: 18.0–106.7) and negative likelihood ratio: 0.03 (95% CI: 0.02–0.04), with an area under ROC (AUROC) curve of 0.99 (95% CI: 0.98–1.00). Meta-regression suggested no significant difference in the diagnostic accuracy for intussusception between POCUS and RADUS (AUROC: 0.95 vs 1.00, p = 0.128).

      Conclusions

      Current evidence suggested POCUS has a high diagnostic accuracy for intussusception not significantly different from that of RADUS.

      Abbreviation:

      POCUS (point-of-care ultrasound), RADUS (radiology-performed ultrasound)

      Keywords

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      References

        • Buettcher M.
        • Baer G.
        • Bonhoeffer J.
        • Schaad U.B.
        • Heininger U.
        Three-year surveillance of intussusception in children in Switzerland.
        Pediatrics. 2007; 120: 473-480
        • West K.W.
        • Stephens B.
        • Vane D.W.
        • Grosfeld J.L.
        Intussusception: current management in infants and children.
        Surgery. 1987; 102: 704-710
        • Yamamoto L.G.
        • Morita S.Y.
        • Boychuk R.B.
        • et al.
        Stool appearance in intussusception: assessing the value of the term “currant jelly”.
        Am J Emerg Med. 1997; 15: 293-298
        • Lam S.H.
        • Wise A.
        • Yenter C.
        Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review.
        World J Emerg Med. 2014; 5: 255-258
        • Ogundoyin O.O.
        • Olulana D.I.
        • Lawal T.A.
        Childhood intussusception: impact of delay in presentation in a developing country.
        Afr J Paediatr Surg. 2016; 13: 166-169
        • Hryhorczuk A.L.
        • Strouse P.J.
        Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception.
        Pediatr Radiol. 2009; 39: 1075-1079
        • Verschelden P.
        • Filiatrault D.
        • Garel L.
        • et al.
        Intussusception in children: reliability of US in diagnosis—a prospective study.
        Radiology. 1992; 184: 741-744
        • Ko H.S.
        • Schenk J.P.
        • Troger J.
        • Rohrschneider W.K.
        Current radiological management of intussusception in children.
        Eur Radiol. 2007; 17: 2411-2421
        • Eshed I.
        • Gorenstein A.
        • Serour F.
        • Witzling M.
        Intussusception in children: can we rely on screening sonography performed by junior residents?.
        Pediatr Radiol. 2004; 34: 134-137
        • American College of Emergency P
        Emergency ultrasound guidelines.
        Ann Emerg Med. 2009; 53: 550-570
        • Kairam N.
        • Kaiafis C.
        • Shih R.
        Diagnosis of pediatric intussusception by an emergency physician-performed bedside ultrasound: a case report.
        Pediatr Emerg Care. 2009; 25: 177-180
        • Riera A.
        • Hsiao A.L.
        • Langhan M.L.
        • Goodman T.R.
        • Chen L.
        Diagnosis of intussusception by physician novice sonographers in the emergency department.
        Ann Emerg Med. 2012; 60: 264-268
        • Leeflang M.M.
        • Deeks J.J.
        • Gatsonis C.
        • Bossuyt P.M.
        • Cochrane Diagnostic Test Accuracy Working Group
        Systematic reviews of diagnostic test accuracy.
        Ann Intern Med. 2008; 149: 889-897
        • McInnes M.D.F.
        • Moher D.
        • Thombs B.D.
        • et al.
        Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement.
        JAMA. 2018; 319: 388-396
        • Whiting P.F.
        • Rutjes A.W.
        • Westwood M.E.
        • et al.
        QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies.
        Ann Intern Med. 2011; 155: 529-536
        • Arends L.R.
        • Hamza T.H.
        • van Houwelingen J.C.
        • Heijenbrok-Kal M.H.
        • Hunink M.G.
        • Stijnen T.
        Bivariate random effects meta-analysis of ROC curves.
        Med Decis Making. 2008; 28: 621-638
        • Harbord R.M.
        • Whiting P.
        • Sterne J.A.
        • et al.
        An empirical comparison of methods for meta-analysis of diagnostic accuracy showed hierarchical models are necessary.
        J Clin Epidemiol. 2008; 61: 1095-1103
        • Higgins J.P.
        • Thompson S.G.
        • Deeks J.J.
        • Altman D.G.
        Measuring inconsistency in meta-analyses.
        BMJ. 2003; 327: 557-560
        • van Enst W.A.
        • Ochodo E.
        • Scholten R.J.
        • Hooft L.
        • Leeflang M.M.
        Investigation of publication bias in meta-analyses of diagnostic test accuracy: a meta-epidemiological study.
        BMC Med Res Methodol. 2014; 14: 70
        • Duval S.
        • Tweedie R.
        Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.
        Biometrics. 2000; 56: 455-463
        • Galbraith R.F.
        Graphical display of estimates having differing standard errors.
        Technometrics. 1988; 30: 271-281
        • Zerzan J.
        • Arroyo A.
        • Dickman E.
        • Vazquez H.
        Diagnosing intussusception by bedside ultrasonography in the pediatric emergency department.
        in: Society for Academic Emergency Medicine annual meeting abstracts. 2012: s83-s84
        • Trigylidas T.E.
        • Kelly J.C.
        • Hegenbarth M.A.
        • Kennedy C.
        • Patel L.
        • O'Rourke K.
        395 pediatric emergency medicine-performed Point-of-Care Ultrasound (POCUS) for the diagnosis of intussusception.
        Ann Emerg Med. 2017; 70: S155
        • Muniz A.
        Ultrasound diagnosis of intussusception by emergency physicians.
        in: Society for Academic Emergency Medicine annual meeting abstracts. 2010: s42
        • John S.D.
        The value of ultrasound in children with suspected intussusception.
        Emerg Radiol. 1998; 5: 297-305
        • Ja Lim K.
        • Lee K.
        • Yoon D.Y.
        • et al.
        The role of US in finding intussusception and alternative diagnosis: a report of 100 pediatric cases.
        Acta Radiol. 2015; 56: 228-233
        • Henrikson S.
        • Blane C.E.
        • Koujok K.
        • Strouse P.J.
        • DiPietro M.A.
        • Goodsitt M.M.
        The effect of screening sonography on the positive rate of enemas for intussusception.
        Pediatr Radiol. 2003; 33: 190-193
        • Henderson A.A.
        • Anupindi S.A.
        • Servaes S.
        • et al.
        Comparison of 2-view abdominal radiographs with ultrasound in children with suspected intussusception.
        Pediatr Emerg Care. 2013; 29: 145-150
        • Harrington L.
        • Connolly B.
        • Hu X.
        • Wesson D.E.
        • Babyn P.
        • Schuh S.
        Ultrasonographic and clinical predictors of intussusception.
        J Pediatr. 1998; 132: 836-839
        • Bhisitkul D.M.
        • Listernick R.
        • Shkolnik A.
        • et al.
        Clinical application of ultrasonography in the diagnosis of intussusception.
        J Pediatr. 1992; 121: 182-186
        • van Houwelingen L.T.
        • Seims A.D.
        • Ortega-Laureano L.
        • et al.
        Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review.
        Pediatr Radiol. 2018; 48: 204-209
        • Stanley A.
        • Logan H.
        • Bate T.W.
        • Nicholson A.J.
        Ultrasound in the diagnosis and exclusion of intussusception.
        Ir Med J. 1997; 90: 64-65
        • Smoljanitsh Z.
        • Zhivitsh G.
        • Krstitsh Z.
        • Milanovitsh D.
        • Vukanitsh D.
        • Lukach R.
        Intestinal intussusception in children. Ultrasonic diagnosis.
        Srp Arh Celok Lek. 2000; 128: 259-261
        • Shanbhogue R.L.K.
        • Hussain S.M.
        • Meradji M.
        • Robben S.G.F.
        • Vernooij J.E.M.
        • Molenaar J.C.
        Ultrasonography is accurate enough for the diagnosis of intussusception.
        J Pediatr Surg. 1994; 29: 324-328
        • Pracros J.P.
        • Tran-Minh V.A.
        • Morin D.F.C.H.
        • Deffrenne-Pracros P.
        • Louis D.
        • Basset T.
        Acute intestinal intussusception: ultrasonic diagnosis and air insufflation.
        Pédiatrie (Marseille). 1990; 45: 109-113
        • Jones T.
        • Das I.
        • Au-Yong K.
        • Johnson K.
        An evaluation of the diagnostic accuracy of ultrasound in the diagnosis of paediatric intussusceptions.
        Clin Radiol. 2012; 67: S5
        • Arnaud O.
        • Weil D.
        • Boscq M.
        • Michel L.
        • Robert M.
        Value of ultrasonics in the diagnosis of acute intestinal invagination in infants and children. Apropos of a series of 60 cases.
        Arch Fr Pediatr. 1996; 43: 407-408
        • Usang U.
        • Inah G.
        • Inyang A.
        • Ekabua A.
        Intussusception in children: comparison between ultrasound diagnosis and operation findings in a tropical developing country.
        Afr J Paediatr Surg. 2013; 10: 87-90
        • Wright J.E.
        • Slater S.
        Suspected intussusception: is ultrasound a reliable diagnostic aid?.
        Aust N Z J Surg. 1996; 66: 686-687
        • Wood S.K.
        • Kim J.S.
        • Suh S.J.
        • Paik T.W.
        • Choi S.O.
        Childhood intussusception: US-guided hydrostatic reduction.
        Radiology. 1992; 182: 77-80
        • Sarihan H.
        • Dinc H.
        • Abes M.
        • Cay A.
        • Serce K.
        The role of sonography in diagnosis of intussusception.
        Pediatrik Cerrahi Dergisi. 1996; 10: 32-35
        • Lin W.C.
        • Lin C.H.
        Re-appraising the role of sonography in pediatric acute abdominal pain.
        Iran J Pediatr. 2013; 23: 177-182
        • Kim J.H.
        • Lee J.Y.
        • Kwon J.H.
        • Cho H.R.
        • Lee J.S.
        • Ryu J.M.
        Point-of-care ultrasound could streamline the emergency department workflow of clinically nonspecific intussusception.
        Pediatr Emerg Care. 2017; https://doi.org/10.1097/PEC.0000000000001283
        • Justice F.A.
        • de Campo M.
        • Liem N.T.
        • Son T.N.
        • Ninh T.P.
        • Bines J.E.
        Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam.
        Pediatr Radiol. 2007; 37: 195-199
        • Chang Y.J.
        • Hsia S.H.
        • Chao H.C.
        Emergency medicine physicians performed ultrasound for pediatric intussusceptions.
        Biom J. 2013; 36: 175-178
        • Barzilai M.
        Ultrasound in suspected intussusception.
        Harefuah. 1994; 127: 5-8, 64
        • Lim H.K.
        • Bae S.H.
        • Lee K.H.
        • Seo G.S.
        • Yoon G.S.
        Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography.
        Radiology. 1994; 191: 781-785
        • Marin J.R.
        • Abo A.M.
        • Arroyo A.C.
        • et al.
        Pediatric emergency medicine point-of-care ultrasound: summary of the evidence.
        Crit Ultrasound J. 2016; 8: 16
        • Ko S.F.
        • Tiao M.M.
        • Hsieh C.S.
        • et al.
        Pediatric small bowel intussusception disease: feasibility of screening for surgery with early computed tomographic evaluation.
        Surgery. 2010; 147: 521-528