title: The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception.
abstract: 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.
  
  
  METHODS
  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.
authors: Pediatrics/Section of Emergency Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX 77030, USA. drmendez@texaschildrens.org
authors: Donna
authors: D
authors: Mendez
authors: A Chantal
authors: AC
authors: Caviness
authors: Long
authors: L
authors: Ma
authors: Charles C
authors: CC
authors: Macias
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D053609:Lethargy / Q000209:etiology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology