title: The utility of the contrast enema in neonates with suspected Hirschsprung disease.
abstract: OBJECTIVE
  The contrast enema (CE) is commonly utilized for suspected Hirschsprung disease (HD) patients. We set out to determine the utility of the CE in the newborn for clinically suspicious HD.
  
  
  METHODS
  All CEs performed for suspicion of HD in neonates from January 2004 to December 2013 were reviewed by two pediatric radiologists who were blinded to the original interpretations and final diagnoses. A standardized scoring sheet was utilized to document essential radiographic findings. Definitive diagnoses were determined by pathology. Descriptive statistics, likelihood ratios, and interrater agreement were determined.
  
  
  RESULTS
  158 CEs were reviewed. Interrater agreement was 89% with kappa (95% CI) of 0.63 (0.47-0.76). Common indications for CE were similar between non-HD and HD groups. The positive, inconclusive, and negative likelihood ratios (95% CI) were 38 (10-172), 3.2 (1.3-9.1), and 0.15 (0.06-0.47), respectively, leading to posttest probabilities for positive, inconclusive, and negative tests of 83%, 32%, and 2.5%, respectively.
  
  
  CONCLUSIONS
  Although radiographic positive CE for HD portends a high probability of HD, inconclusive studies still represent a significant increased risk. In clinically suspicious infants for HD, those with inconclusive studies may benefit from a lower threshold to perform follow-up rectal biopsy.
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX.
authors.forename: Luke R
authors.initials: LR
authors.lastname: Putnam
authors.affiliation: Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX; Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX.
authors.forename: Susan D
authors.initials: SD
authors.lastname: John
authors.affiliation: Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX; Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2.130B, Houston, TX.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Greenfield
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Kellagher
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Austin
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Lally
authors.affiliation: Center for Surgical Trials and Evidence-based Practice, Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, TX; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX. Electronic address: kuojen.tsao@uth.tmc.edu.
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
mesh_terms: D001466:Barium Sulfate; D001706:Biopsy; D003287:Contrast Media; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011860:Radiography, Abdominal; D012007:Rectum / Q000473:pathology
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate
keywords: Barium enema; Contrast enema; Hirschsprung disease