The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception.

OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of an abdominal ultrasound to that of a highly suggestive abdominal radiograph combined with signs and symptoms of intussusception.

DESIGN: This was a retrospective cross-sectional study of children 3 years or younger with signs and symptoms of intussusceptions who presented to a pediatric emergency department (ED). Univariate analysis, multivariate analysis, and diagnostic accuracy of clinical characteristics and radiographic findings were derived.

RESULTS: A highly suggestive abdominal radiograph (14.80; 5.85-37.45), right upper quadrant mass (8.90; 1.14-69.47), vomiting (2.54; 1.36-4.76), and abdominal pain (2.45; 1.36-4.40) were found to be significantly associated with intussusception by univariate analysis. Vomiting (2.80; 1.34-5.85), abdominal pain (2.75; 1.33-5.69), and bloody stools (2.70; 1.07-6.81) were independently associated with intussusceptions by multivariate analysis. Bloody stools were time dependent. Bloody stools occurred in those patients with intussusception at a median time of 24 hours, from the time the patient started with signs and symptoms to the time of presentation to the ED, vs those without bloody stools presenting at a median time of 11 hours. The combination of a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting was highly specific (95%) for intussusception, comparable to that of an ultrasound (93%). In patients with this combination, all were found to have intussusception by enema or surgery.

CONCLUSIONS: Ultrasound is not needed before an enema for the diagnosis of intussusception for those with a highly suggestive abdominal radiograph, abdominal pain, lethargy, and vomiting.