title: Comparative Effectiveness of Imaging Modalities for the Diagnosis and Treatment of Intussusception: A Critically Appraised Topic.
abstract: The purpose of this study was to critically appraise and compare the diagnostic performance of imaging modalities that are used for the diagnosis of intussusception and methods used in the treatment of ileocolic intussusception.
  
  
  
  A focused clinical question was constructed and the literature was searched using the patient, intervention, comparison, outcome (PICO) method comparing radiography, ultrasound, and computed tomography in the detection of intussusception. The same methods were used to compare pneumatic (gas) reduction and hydrostatic (liquid) reduction using saline, water-soluble contrast, and barium. Retrieved articles were appraised and assigned a level of evidence based on the Oxford University Centre for Evidence-Based Medicine hierarchy of validity for diagnostic studies.
  
  
  
  The retrieved sensitivity for the diagnosis of intussusception using plain radiography is 48% (95% confidence interval [CI], 44%-52%), with a specificity of 21% (95% CI, 18%-24%). The retrieved sensitivity for the diagnosis of intussusception using ultrasound is 97.9% (95% CI, 95%-100%), with a specificity of 97.8% (95% CI, 97%-99%). Based on a good quality meta-analysis, the combined success rate of gas enema reduction was shown to be 82.7% (95% CI, 79.9%-85.6%) compared to a combined success rate of 69.6% (95% CI, 65.0%-74.1%) for liquid enema reduction.
  
  
  
  The best available evidence recommends ultrasound as the diagnostic modality of choice for the diagnosis of ileocolic intussusception in children. In stable children without signs of peritonism, nonoperative reduction is the treatment of choice. Pneumatic (gas) reduction enema has been shown to be superior to hydrostatic (liquid) enema reduction.
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. Electronic address: annegcarroll@gmail.com.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Carroll
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Kavanagh
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: Caoilfhionn
authors.initials: C
authors.lastname: Ni Leidhin
authors.affiliation: Department of Pediatrics, Our Lady's Children's Hospital, Dublin, Ireland.
authors.forename: Noelle M
authors.initials: NM
authors.lastname: Cullinan
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: Lisa P
authors.initials: LP
authors.lastname: Lavelle
authors.affiliation: Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
authors.forename: Dermot E
authors.initials: DE
authors.lastname: Malone
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D019468:Disease Management; D006801:Humans; D007443:Intussusception / Q000175:diagnosis* / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods
keywords: Evidence-based medicine; confidence interval; diagnosis; enema reduction; intussusception; large bowel obstruction; likelihood ratio; lower gastrointestinal tract; negative predictive value; positive predictive value; sensitivity and specificity; small bowel obstruction