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Am J Emerg Med. 2019 Jun 4. pii: S0735-6757(19)30383-3. doi: 10.1016/j.ajem.2019.06.006. [Epub ahead of print]

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

Author information

1
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX, USA.
2
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
3
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
4
Department of Pediatric Emergency Medicine, The University of Texas at Austin School of Medicine, Austin, TX, USA.
5
Department of Emergency Medicine, John Peter Smith Hospital, Fort Worth, TX, USA.
6
Department of Medical Imaging, Changhua Christian Hospital, Changhua, Taiwan.
7
Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA.
8
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: cclee100@gmail.com.

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.

KEYWORDS:

Diagnostic accuracy; Intussusception; Meta-analysis; Point-of-care ultrasound

PMID:
31182360
DOI:
10.1016/j.ajem.2019.06.006

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