title: Ability of pediatric physicians to judge the likelihood of intussusception.
abstract: BACKGROUND
  Intussusception is the most common cause of intestinal obstruction in infants and children. To date, no study has evaluated the ability of physicians to predict the likelihood of intussusception.
  
  
  OBJECTIVE
  This study aimed to determine the ability of pediatric physicians to predict intussusception in patients being evaluated for intussusception and to investigate whether certain clinical findings correlate with physicians' risk assessment.
  
  
  METHODS
  A prospective cohort study of children aged 1 month to 6 years who presented with possible intussusception. The predicted likelihood of intussusception was recorded by physicians before knowledge of imaging results or final diagnosis. We defined a physician's prediction as high versus low risk based on a threshold prediction of 25% likelihood.
  
  
  RESULTS
  A total of 308 patients were studied including 38 (12.3%) with intussusception. Physicians' prediction was positively associated with the risk of intussusception (test for linear trend: odds ratio [OR], 2.1; 95% confidence interval [CI], 1.6-2.7; P < 0.001). Among patients considered high risk, the rate of intussusception was 36% (95% CI, 25%-49%) compared with 6% for those judged to be low risk (95% CI, 4%-10%). Using a threshold of 25% likelihood, successful prediction of high versus low risk occurred in 82% (95% CI, 77%-86%). Clinical predictors associated with assigning a designation of higher risk of intussusception included lethargy at home (OR, 2.7; 95% CI, 1.4-5.5) and bloody stool (OR, 2.5; 95% CI, 1.0-5.9).
  
  
  CONCLUSIONS
  Pediatric physicians can accurately predict the likelihood of intussusception. This ability to properly judge the risk of intussusception can be incorporated into management strategies.
authors.affiliation: Division of Emergency Medicine, Children's Hospital, Boston, MA, USA. sweihmiller@gmail.com
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Weihmiller
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D001064:Appendicitis / Q000175:diagnosis / Q000523:psychology; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D005544:Forecasting; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007443:Intussusception / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D007600:Judgment; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics; D010808:Physical Examination; D010820:Physicians / Q000523:psychology*; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D014839:Vomiting / Q000209:etiology