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Meta-Analysis
. 2020 Jul 2;21(4):1008-1016.
doi: 10.5811/westjem.2020.4.46241.

Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis

Margaret Lin-Martore  1 , Aaron E Kornblith  1 , Michael A Kohn  2   3 , Michael Gottlieb  4
Affiliations
Meta-Analysis

Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis

Margaret Lin-Martore et al. West J Emerg Med. .

Abstract

Introduction: Ileocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception by emergency physicians (EP).

Methods: We conducted a systematic search on PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, as well as conference abstracts, and assessed bibliographies of selected articles for all studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. We dual extracted data into a predefined worksheet and performed quality analysis with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed.

Results: Six studies (n = 1303 children) met our inclusion criteria. Overall, 11.9% of children had intussusception. POCUS was 94.9% (95% confidence interval [CI], 89.9% to 97.5%) sensitive and 99.1% (95% CI, 94.7% to 99.8%) specific with a likelihood ratio (LR)+ of 105 (95% CI, 18 to 625) and a LR- of 0.05 (95% CI, 0.03 to 0.10).

Conclusion: POCUS by EPs is highly sensitive and specific for the identification of intussusception for children presenting to the emergency department.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. No additional articles were identified through bibliographic review.
Figure 2
Figure 2
Forest plot with all included studies.
Figure 3
Figure 3
Summary receiver operating characteristic (SROC) curve with all studies. 1=Lam, 2=Muniz, 3=Riera, 4=Trigylidas, 5=Zerzan, 6=Lin. SENS, sensitivity; SPEC, specificity; AUC, area under the curve.
Figure 4
Figure 4
Funnel plot with all included studies. 1=Lam, 2=Muniz, 3=Riera, 4=Trigylidas, 5=Zerzan, 6=Lin. ESS, effective sample size.
Figure 5
Figure 5
Intussusception scanning protocol. Initially published online on ALIEMU.com and permission to use given by author MLM.
See this image and copyright information in PMC

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