Validation of clinical case definition of acute intussusception in infants in Viet Nam and Australia.
OBJECTIVE
To test the sensitivity and specificity of a clinical case definition of acute intussusception in infants to assist health-care workers in settings where diagnostic facilities are not available.


METHODS
Prospective studies were conducted at a major paediatric hospital in Viet Nam (the National Hospital of Pediatrics, Hanoi) from November 2002 to December 2003 and in Australia (the Royal Children's Hospital, Melbourne) from March 2002 to March 2004 using a clinical case definition of intussusception. Diagnosis of intussusception was confirmed by air enema or surgery and validated in a subset of participants by an independent clinician who was blinded to the participant's status. Sensitivity of the definition was evaluated in 584 infants aged<2 years with suspected intussusception (533 infants in Hanoi; 51 in Melbourne). Specificity was evaluated in 638 infants aged<2 years presenting with clinical features consistent with intussusception but for whom another diagnosis was established (234 infants in Hanoi; 404 in Melbourne).


RESULTS
In both locations the definition used was sensitive (96% sensitivity in Hanoi; 98% in Melbourne) and specific (95% specificity in Hanoi; 87% in Melbourne) for intussusception among infants with sufficient data to allow classification (449/533 in Hanoi; 50/51 in Melbourne). Reanalysis of patients with missing data suggests that modifying minor criteria would increase the applicability of the definition while maintaining good sensitivity (96-97%) and specificity (83-89%).


CONCLUSIONS
The clinical case definition was sensitive and specific for the diagnosis of acute intussusception in infants in both a developing country and a developed country but minor modifications would enable it to be used more widely.
Bines
Julie E
JE
Murdoch Children's Research Institute, Melbourne, Australia. julie.bines@rch.org.au
Liem
Nguyen Thanh
NT
Justice
Frances
F
Son
Tran Ngoc
TN
Carlin
John B
JB
de Campo
Margaret
M
Jamsen
Kris
K
Mulholland
Kim
K
Barnett
Peter
P
Barnes
Graeme L
GL
D000208:Acute Disease; D019937:Diagnostic Techniques and Procedures; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000175:diagnosis*; D008297:Male; D011446:Prospective Studies; D014739:Victoria; D014744:Vietnam