Published online Jul 26, 2023. doi: 10.12998/wjcc.v11.i21.5014
Peer-review started: March 16, 2023
First decision: June 12, 2023
Revised: June 18, 2023
Accepted: June 27, 2023
Article in press: June 27, 2023
Published online: July 26, 2023
Intussusception is the most common cause of intestinal obstruction in young children. Bowel infarction and perforation, leading to peritonitis and death, are the more serious complications of late or missed diagnoses. Abdominal ultrasonography (USG) is the gold standard of investigation, but these procedures require an experienced radiologist and timely availability of the USG machine that is often limited.
To develop a user-friendly tool that could help front-line doctors diagnose intussusception in resource limited areas to improve clinical case management.
The present study aimed to study the demographic data, disease characteristics, and management of children with suspected intussusception, and to describe the user-friendly parameters that are helpful for general physicians to diagnose intussusception.
Medical records of 151 children, aged less than 18 years, who had clinically suspected intussusception and had completed abdominal radiography (AR) and abdomen USG procedures as part of the work-up during evaluation by pediatric residents at King Chulalongkorn Memorial Hospital from January 2006 to June 2018 were included in the present study. Diagnostic sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated for AR with and without promising parameters to diagnose intussusception. USG is considered the gold standard to diagnose intussusception.
One hundred and fifty-one children with suspected intussusception were included in the study with a mean age of 2.47 ± 3.09 years, with 64.2% of them were male. Characteristics that could discriminate intussusception from non-intussusception included children aged 6 mo to 2 years old, pallor, abdominal mass, and positive AR (P < 0.05). AR images (n = 133) were interpreted blindly by a pediatric radiologist and had a sensitivity, specificity, PPV, and NPV to diagnose intussusception of 59.2%, 70.9%, 78.4%, and 49.4%, respectively. Promising parameters including common age group, common manifestations (abdominal pain or irritability, vomiting, and abdominal distension), significant manifestations that could discriminate intussusception and other mimic diseases (pallor and palpable mass), and AR images were chosen and combined to establish models that could help general physicians to identify suspected intussusception prior to timely confirmation by abdomen USG. The combination of the user-friendly triad (children aged 6 mo to 2 years old, abdominal pain or irritability, and AR) that we termed the “Pediatric Intussusception Score” showed diagnostic value for intussusception with a sensitivity of 85.7% and an area under the receiver operating characteristic curve of 0.704 (95% confidence interval: 0.616-0.790).
AR is considered a poor diagnostic tool for intussusception. It is operator independent and front-line doctors in rural areas can use this tool to identify suspected cases of intussusception. Positive AR could help the doctor to decide which cases to refer to secondary or tertiary hospitals for specific and timely management in time. Two clinical parameters that doctors should be aware with intussusception were integrated into the PIS. The PIS will help young doctors have confidence to make initial diagnoses of intussusception.
Further study to validate the PIS for the diagnosis of intussusception is warranted.