Clinical diagnosis of pyloric stenosis: a declining art.
OBJECTIVE
To assess whether diagnostic imaging of pyloric stenosis has made a difference in rapidity of diagnosis, duration of pre-operative hydration, and length of stay in hospital.


METHODS
Chart review of infants with confirmed diagnosis of pyloric stenosis.


METHODS
Paediatric teaching hospital.


METHODS
215 infants with a confirmed diagnosis of pyloric stenosis seen during 1974-7 and 187 infants with pyloric stenosis seen during 1988-91.


METHODS
State of hydration on admission, time between presentation to hospital and a definite diagnosis, techniques used to make the diagnosis, whether a pyloric mass was felt before or after an imaging procedure, time between presentation and surgery, and length of stay in hospital.


RESULTS
The average age at presentation was 40 days in both groups. A pyloric mass was palpated either without or before an imaging study in 87% (187/215) of cases during 1974-7 but in only 49% (91/187) during 1988-91. The use of barium meal examination and ultrasonography increased from 20% (42/215) of cases during 1974-7 to 61% (114/187) during 1988-91. There were no significant differences between the two groups in the time taken to establish a diagnosis, the mean duration of preoperative treatment, or the length of stay in hospital (after allowance for the decline in average length of stay of all hospital patients between the two periods).


CONCLUSIONS
An increased use of diagnostic imaging for pyloric stenosis did not lead to earlier diagnosis or better management. While imaging is important in identifying pyloric stenosis in difficult cases, increasing reliance on imaging has reduced doctors' skills in diagnosing pyloric stenosis clinically.
Macdessi
J
J
Sydney University, Department of Paediatrics and Child Health, Children's Hospital, Camperdown, Australia.
Oates
R K
RK
D000367:Age Factors; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D010173:Palpation; D011707:Pyloric Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography; D012737:Sex Factors; D013997:Time Factors; D014463:Ultrasonography