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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Alazraki AL, Rigsby CK, Iyer RS, et al. ACR Appropriateness Criteria® Vomiting in Infants. J Am Coll Radiol 2020;17:S505-S15. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for vomiting in infants. No results stated in abstract. 4
2. Chang KJ, Marin D, Kim DH, et al. ACR Appropriateness Criteria® Suspected Small-Bowel Obstruction. J Am Coll Radiol 2020;17:S305-S14. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected small-bowel obstruction. No results stated in abstract. 4
3. Kambadakone AR, Santillan CS, Kim DH, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022;19:S445-S61. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for right lower quadrant pain. No results stated in abstract. 4
4. Gokli A, Dillman JR, Humphries PD, et al. Contrast-enhanced ultrasound of the pediatric bowel. Pediatr Radiol. 2021 Nov;51(12):2214-2228. Review/Other-Dx N/A To present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies.To discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion. No results in abstract. 4
5. Caglar O, Cesur E, Sade R, et al. Dual energy CT in necrotizing enterocolitis; a novel diagnostic approach. Turkish Journal of Medical Sciences. 51(5):2575-2583, 2021 Oct. Observational-Dx 21 patients with NEC stages 2-A, 2-B and 3-A To demonstrate the importance of dual-energy computed tomography (DECT) in confirming intestinal ischemia in neonates with necrotizing enterocolitis (NEC). DECT was performed in 21 patients with NEC stages 2-A, 2-B and 3-A. Twelve patients (57.1%) without ischemia were followed up without surgery. Nine patients (42.9%) with ischemia on DECT were operated on, and resection and anastomosis or ileostomy and colostomy were performed. 3
6. Gonzalez-Moreno IM, Plasencia-Martinez JM, Blanco-Barrio A, Moreno-Pastor A. Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen?. [Review]. Radiologia. 61(2):161-166, 2019 Mar - Apr. Review/Other-Dx N/A To evaluate the effects of omitting the use of this type of oral contrast material for computed tomography examinations required in the emergency department for suspicion of acute abdominal pathology through an efficient literature search among recent publications. No results in abstract. 4
7. Loening-Baucke V, Swidsinski A. Constipation as cause of acute abdominal pain in children. J Pediatr 2007;151:666-9. Review/Other-Dx 962 children, > or = 4 years old, seen at least 1 health maintenance visit during a 6-month period for acute abdominal pain To evaluate the causes of acute abdominal pain in a large academic pediatric primary care population. We found that 9% of the 962 children had a visit for acute abdominal pain, with significantly more girls (12%) than boys (5%) having this complaint. Acute and chronic constipation were the most frequent causes of acute abdominal pain, occurring in 48% of subjects. A surgical cause was present in 2% of subjects. The cause for the acute abdominal pain remained unknown in 19% of subjects. We did not find significant differences in diagnoses in the primary care clinics versus emergency department. 4
8. Tabbers MM, DiLorenzo C, Berger MY, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 2014;58:258-74. Review/Other-Dx N/A To assist medical care providers in the evaluation and management of children with functional constipation, the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition were charged with the task of developing a uniform document of evidence-based guidelines. This evidence-based guideline provides recommendations for the evaluation and treatment of children with functional constipation to standardize and improve their quality of care. In addition, 2 algorithms were developed, one for the infants <6 months of age and the other for older infants and children. 4
9. Doniger SJ, Dessie A, Latronica C. Measuring the Transrectal Diameter on Point-of-Care Ultrasound to Diagnose Constipation in Children. Pediatric Emergency Care. 34(3):154-159, 2018 Mar. Observational-Dx 50 pediatric patients between the age of 4 and 17 years, presenting with abdominal pain to a pediatric emergency department To determine the test performance characteristics for point-of-care ultrasound in diagnosing constipation, through measuring the transrectal diameter (TRD).To develop a sonographic numeric cutoff value for diagnosing constipation. Fifty subjects were "constipated" or "nonconstipated," as determined by the Rome III questionnaire. A TRD cutoff of 3.8 cm or greater correlated with the diagnoses of constipation (P < 0.001). Ultrasound-diagnosed constipation had a sensitivity of 86% (95% confidence interval, 69%-96%), specificity of 71% (95% CI, 53%-85%), negative predictive value of 0.87 (95% CI, 0.68-0.95), and positive predictive value of 0.70 (95% CI, 0.52-0.84). The TRD measurement was not affected by patient physical characteristics or bladder fullness. In 7 patients, an enema was administered. There was an overall mean (SD) decrease of 1.22 (1.62) cm; this difference was not statistically significant (P = 0.093). Abdominal radiographs were performed in 25 patients. When compared with abdominal radiographs, ultrasound had a higher specificity of 71% (95% CI, 53%-85%), but this difference was not statistically significant. Ultrasound performed similarly to abdominal radiographs with regard to sensitivity 86% (95% CI, 67%-95%), positive predictive value of 0.70 (95% CI, 0.52-0.84), and negative predictive value of 0.87 (0.68-0.95). In 22 of 25 patients who received radiographs, the ultrasound diagnosis was the same as the radiologist read of the radiographs. Potentially, 88% of radiographs could have been avoided in these patients. 3
10. Kearney R, Edwards T, Bradford M, Klein E. Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation. Pediatric Emergency Care. 35(9):624-629, 2019 Sep. Review/Other-Dx 305 PEM providers To assess the use of plain radiographs by pediatric emergency medicine (PEM) providers in the diagnostic evaluation and management of pediatric constipation. Three hundred five of 1272 Listserv members (24%) responded. Ninety-nine percent elected to treat for constipation in a case meeting Rome III clinical criteria; one third (31%) would obtain plain radiographs for this same scenario. Plain radiographs were viewed as somewhat (59%) or minimally (29%) value-added in the evaluation of suspected pediatric constipation. Obtaining family buy-in (44%) was the most common reason for utilizing plain radiographs. Frequency of use varied across geographic regions and with participant and hospital characteristics. 4
11. Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, Berger MY. Diagnostic value of abdominal radiography in constipated children: a systematic review. Arch Pediatr Adolesc Med 2005;159:671-8. Review/Other-Dx 6 studies To describe and to assess the evidence from observational, controlled studies concerning the association between abdominal radiography and symptoms and signs related to constipation in children. Of the 392 publications identified, 6 studies met the inclusion criteria. Only 2 studies were of high methodological quality. The best-evidence synthesis yielded conflicting evidence for an association between a clinical and a radiological diagnosis of constipation. The likelihood ratio (LR) in 2 high-quality studies was close to 1 (LR, 1.2; 95% confidence interval [CI], 1.0-1.4; and LR, 1.0; 95% CI, 0.5-1.6). Conflicting evidence was found for an association between digital rectal examination and fecal impaction on radiography. Limited evidence was found for an association between a history of hard stool and a finding of rebound tenderness and radiography (LR, 1.2; 95% CI, 1.0-1.4; and LR, 1.1; 95% CI, 1.0-1.2, respectively). 4
12. MacGeorge CA, Williams DC, Vajta N, et al. Understanding the Constipation Conundrum: Predictors of Obtaining an Abdominal Radiograph During the Emergency Department Evaluation of Pediatric Constipation. Pediatric Emergency Care. 35(10):680-683, 2019 Oct. Observational-Dx 326 children To identify predictors associated with obtaining an abdominal radiograph (AR) and to determine if ARs were associated with a longer length of stay (LOS) among children with constipation evaluated in the ED. In total, 326 children met inclusion criteria, and 60% of the children received an AR. In logistic regression, significant predictors included age (odds ratio [OR] = 1.1/year of age, P = 0.004), presenting with abdominal pain as chief complaint compared with constipation (OR = 4.4, P < 0.0001), and history of emesis (OR = 2.8, P = 0.001) after controlling for provider type and previous constipation medication use. In linear regression, the adjusted mean LOS for those with an AR was 163 minutes compared with 117 minutes for those without after controlling for age, provider type, and history of constipation medication use (P < 0.0001). 3
13. Barr RG, Levine MD, Wilkinson RH, Mulvihill D. Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr (Phila) 1979;18:674, 76, 77-9, passim. Review/Other-Dx N/A To determine whether the technique was clinically valid in identifying chronic stool retention, the method was used to evaluate films taken of children with known stool retention before and after therapy. No results in abstract. 4
14. Beckmann KR, Hennes H, Sty JR, Walsh-Kelly CM. Accuracy of clinical variables in the identification of radiographically proven constipation in children. WMJ 2001;100:33-6. Observational-Dx 251 children with abdominal pain (141 with constipation; 110 with no constipation) To determine whether clinical variables accurately identify children with radiographically proven constipation. In total 251 patients were enrolled over a 12 month period. Four variables were noted to be more common in constipated patients: a history of normal or hard stools, absence of rebound tenderness, presence of tenderness in the left lower quadrant and stool in the rectal vault on exam. Stool present on rectal exam was the best discriminator between patients with and without constipation. The discriminant analysis model had a sensitivity of 77%, specificity of 35% and a negative predictive value of 55%. 3
15. Benninga MA, Buller HA, Staalman CR, et al. Defaecation disorders in children, colonic transit time versus the Barr-score. Eur J Pediatr 1995;154:277-84. Review/Other-Dx 211 constipated children To measure segmental and total colonic transit times (CTT) using radio-opaque markers in 211 constipated children in order to objectivate the presence and degree of constipation and evaluate the existence of faecal retention or impaction in children with defaecation disorders. Of the children with constipation, 48% showed significantly prolonged total and segmental CTT. Surprisingly, 91% and 91%, respectively, of the encopresis/soiling and recurrent abdominal pain children had a total CTT within normal limits, suggesting that no motility disorder was present. Prolonged CTT through all segments, known as colonic inertia, was found in the constipation group only. Based on significant differences in clinical presentation, CTT and colonic transit patterns, encopresis/soiling children formed a separate entity among children with defaecation disorders, compared to children with constipation. Recurrent abdominal pain in children was in the great majority, not related to constipation. Barr-scores were poorly reproducible, with low inter- and intra-observer reliability. 4
16. Berger MY, Tabbers MM, Kurver MJ, Boluyt N, Benninga MA. Value of abdominal radiography, colonic transit time, and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children: a systematic review. J Pediatr 2012;161:44-50 e1-2. Meta-analysis 10 To perform a systematic review evaluating the value of abdominal radiography, colonic transit time (CTT), and rectal ultrasound scanning in the diagnosis of idiopathic constipation in children One systematic review summarized 6 studies on abdominal radiography until 2004. The additional 9 studies evaluated abdominal radiography (n = 2), CTT (n = 3), and ultrasound scanning (n = 4). All studies except two used a case-control study design, which will lead to overestimation of test accuracy. Furthermore, none of the studies interpreted the results of the abdominal radiography, ultrasound scanning, or CTT without knowledge of the clinical diagnosis of constipation. The sensitivity of abdominal radiography, as studied in 6 studies, ranged from 80% (95% CI, 65-90) to 60% (95% CI, 46-72), and its specificity ranged from 99% (95% CI, 95-100) to 43% (95% CI, 18-71). Only one study presented test characteristics of CTT, and two studies presented test characteristics of ultrasonography Inadequate
17. Cayan S, Doruk E, Bozlu M, Duce MN, Ulusoy E, Akbay E. The assessment of constipation in monosymptomatic primary nocturnal enuresis. Int Urol Nephrol 2001;33:513-6. Observational-Dx 679 children with primary nocturnal enuresis To assess the incidence of constipation in children with or without monosymptomatic primary nocturnal enuresis. Constipation, defined as less than 3 bowel movements per week, was seen in 48 of 679 children with nocturnal enuresis (7.06%). Of those 4671 children without nocturnal enuresis, only 68 (1.45%) had constipation. The difference in constipation between the two groups was statistically significant (z = -9.251; p = 0.000). Of note, 10 of the 125 children (8%), evaluated at the hospital, had constipation. None of the children had an abnormal neurologic examination. Finally, faecal loading was detected on the plain films of 8 of the 125 children evaluated, 7 of who had constipation. The sensitivity of grading plain films for faecal loading to denote constipation in this population was 87.5%. 3
18. de Lorijn F, van Rijn RR, Heijmans J, et al. The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy. Pediatr Radiol 2006;36:43-9. Observational-Dx 89 To assess intra- and interobserver variability and determine diagnostic accuracy of the Leech method in identifying children with functional constipation (FC). Significant intraobserver variability was found between two scorers (P=0.005 and P<0.0001), whereas there was no systematic difference between the two scores of the other scorer (P=0.89). The scores between scorers differed systematically and displayed large variability. The area under the ROC curve was 0.68 (95% CI 0.58-0.80), indicating poor diagnostic accuracy. 2
19. Leech SC, McHugh K, Sullivan PB. Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children. Pediatr Radiol 1999;29:255-8. Observational-Dx 100 To assess the reliability of scoring faecal loading on plain abdominal radiographs in children with intractable constipation. There were significant differences between the scores of the constipated and control radiographs for each observer (P = 0.05). There was no intra-observer variation (P = 0.12-0.69), but significant inter-observer variation was demonstrated (P = 0.00). 1
20. Anwar Ul Haq MM, Lyons H, Halim M. Pediatric Abdominal X-rays in the Acute Care Setting - Are We Overdiagnosing Constipation?. Cureus. 12(3):e7283, 2020 Mar 15.Cureus. 12(3):e7283, 2020 Mar 15. Observational-Dx 1,116 patients (1,383 AXRs) To determine 1) the sensitivity and specificity of plain abdominal x-ray (AXR) in the diagnosis of constipation and 2) the effect of age, race, gender, comorbid conditions, and practice setting on the diagnosis of constipation. Over the three-year study period, 1,383 AXRs were performed on 1,116 patients. The sensitivity of AXR in the diagnosis of constipation was 73.8%, specificity 26.8%, positive predictive value 46.4%, and negative predictive value of 54.3%. Pediatric gastroenterologists were more likely to diagnose constipation (63.2%) compared to pediatricians (41.4%) and pediatric surgeons (33.3%) (p = 0.04). 3
21. Kubiszewski K, Patterson S, Chalise S, Rivera-Sepulveda A. Diagnostic Yield of Abdominal Radiographs in the Pediatric Emergency Department. Pediatric Emergency Care. 40(1):45-50, 2024 Jan 01.Pediatr Emerg Care. 40(1):45-50, 2024 Jan 01. Observational-Dx 4288 ARs To assess the diagnostic yield of abdominal radiographs (ARs) in the evaluation of intraabdominal pathology in the pediatric emergency department (PED). A total of 4288 ARs were identified, with a rate of 6%. The overall abnormal AR rate was 31%. The incidences of an abnormal AR in abdominal pain, vomiting, and constipation were 26%, 37%, and 50%, respectively. There was a 13% rate of clinically significant diagnoses. The AR diagnostic yield showed 44% sensitivity, 70% specificity, 17% positive predictive value, and 90% NPV ( P < 0.05). Unadjusted odds ratio analysis of positive AR and abdominal pain, vomiting, and constipation revealed an odds ratio of 0.68 (95% confidence interval [CI], 0.63-0.75), 1.22 (95% CI, 1.06-1.39), and 1.72 (95% CI, 1.54-1.91), respectively. 4
22. Tate JE, Simonsen L, Viboud C, et al. Trends in intussusception hospitalizations among US infants, 1993-2004: implications for monitoring the safety of the new rotavirus vaccination program. Pediatrics 2008;121:e1125-32. Observational-Dx N/A To assess intussusception hospitalizations trends among US infants for 1993 to 2004; provide estimates of hospitalization rates for intussusception for 2002-2004; and assess variations in background rates by age, race/ethnicity, and surgical management. Annual intussusception hospitalization rates declined 25% from 1993 to 2004 but have remained stable at approximately 35 cases per 100,000 infants since 2000. Rates were very low for infants younger than 9 weeks (<5 per 100,000) then increased rapidly, peaking at approximately 62 per 100,000 at 26 to 29 weeks, before declining gradually to 26 per 100,000 at 52 weeks. Compared with rates among non-Hispanic white infants (27 per 100,000), rates were greater among non-Hispanic black infants (37 per 100,000) and Hispanic infants (45 per 100,000); however, rates did not differ by race/ethnicity for infants who were younger than 16 weeks. 4
23. Lochhead A, Jamjoom R, Ratnapalan S. Intussusception in children presenting to the emergency department. Clinical Pediatrics. 52(11):1029-33, 2013 Nov. Review/Other-Dx 52 children with 170 episodes of intussusceptions To analyze the presentation, treatment, and outcome of children with intussusceptions in a tertiary care emergency department. Around one third (30%) of children diagnosed with intussusceptions had a concurrent infection. There were 114 large bowel intussusceptions, with a mean age of 27 months (SD = 25) and a success rate of 91% for air enema reductions. Bowel resection was performed in 8.8% of children with large bowel intussusceptions. Small bowel intussusceptions (n = 38) were associated with gastrostomy tubes in 42% (n = 16) of patients, and 81% needed tube shortening. 4
24. Ntoulia A, Tharakan SJ, Reid JR, Mahboubi S. Failed Intussusception Reduction in Children: Correlation Between Radiologic, Surgical, and Pathologic Findings. AJR. American Journal of Roentgenology. 207(2):424-33, 2016 Aug. Review/Other-Dx 543 children who underwent reduction of intussusception with the use of an enema technique To identify causes of irreducible intussusception after contrast enema and to correlate imaging findings with surgical and histopathologic findings. Ultrasound detected 56 of 57 cases of intussusception, but it failed to detect the lead point in three cases and failed to detect ischemic necrosis in seven cases. Positive predictors of failed enema reduction were the presence of a distal mass and observation of the dissecting sign. Of the 72 patients who underwent surgical treatment of intussusception, 26 (36.1%) underwent laparoscopy, 38 (52.8%) underwent laparotomy, and eight (11.1%) underwent conversion from laparoscopy to laparotomy. Surgical reduction was performed in 61.1% of cases, small bowel resection in 19.4%, ileocecectomy in 12.5%, and self-reduction in 69%. Pathologic lead points (noted in 25% of cases) included lymphoid hyperplasia (n = 7), Meckel diverticulum (n = 3), Burkitt lymphoma (n = 3), enteric duplication cyst (n = 2), juvenile polyp (n = 2), and adenovirus appendicitis (n = 1). The length of the hospital stay was significantly longer after laparotomy. 4
25. Yang G, Wang X, Jiang W, Ma J, Zhao J, Liu W. Postoperative intussusceptions in children and infants: a systematic review. [Review]. Pediatric Surgery International. 29(12):1273-9, 2013 Dec. Review/Other-Dx 26 studies (127 cases of POI) To evaluate the clinical features of postoperative intussusception (POI) through a literature review. Twenty-six studies with total 127 cases of POI were included. According to the extracted data, the median age was 19 months with the male-to-female ratio 1.5:1. There were 65 operations (51.2 %) that involved gastrointestinal system, 26 cases (20.5 %) of retroperitoneal tumor resection, 12 operations (9.4 %) involved diaphragm, 8 operations (6.3 %) involved urinary system, 5 cases (3.9 %) of partial pancreatectomy, 11 cases (8.7 %) of non-abdominal operations. 75.5 % presented symptoms in the first 7 days after surgery. The prominent symptom was bilious vomiting or increased nasogastric output (87.1 % of 101 patients), following abdominal distention (74.3 %), abdominal pain (35.6 %). Six cases (5.0 %) of ileocolic POI were reduced successfully by air enema. The small bowel intussusception attributed 85.6 % of POI (95 patients). Laparotomy and manual reduction were performed in 104 cases (86.0 %). Nine patients (7.4 %) underwent intestinal resection and anastomosis. 4
26. Lioubashevsky N, Hiller N, Rozovsky K, Segev L, Simanovsky N. Ileocolic versus small-bowel intussusception in children: can US enable reliable differentiation?. Radiology. 269(1):266-71, 2013 Oct. Observational-Dx 174 patients (200 cases of intussusception) To assess clinical and ultrasonographic (US) criteria that can be used to confidently differentiate ileocolic from small-bowel intussusception. There were 200 cases of intussusception in 174 patients (126 boys, 48 girls; mean age, 17.2 months (range, 0 years to 7 years 1 month); 57 (28.5%) were small-bowel and 143 (71.5%) were ileocolic intussusceptions. Mean lesion diameter was 2.63 cm (range, 1.3-4.0 cm) for ileocolic versus 1.42 cm (range, 0.8-3.0 cm) for small-bowel intussusception (P < .0001). Mean fat core diameter was 1.32 cm (range, 0.6-2.2 cm) for ileocolic versus 0.1 cm (range, 0-0.75 cm) for small-bowel intussusception (P < .0001). The ratio of inner fat core diameter to outer wall thickness was greater than 1.0 in all ileocolic intussusceptions and was less than 1.0 in all small-bowel intussusceptions (P < .0001). Lymph nodes inside the lesion were seen in 128 (89.5%) of the 143 ileocolic intussusceptions versus in eight (14.0%) of the 57 small-bowel intussusceptions (P < .0001). Children with ileocolic intussusception had more severe clinical symptoms and signs, with more vomiting (P = .003), leukocytosis (P = .003), and blood in the stool (P = .00005). 3
27. Mbaga M, Msuya D, Mboma L, et al. Intussusception among infants in Tanzania: findings from prospective hospital-based surveillance, 2013-2016. The Pan African medical journal. 39(Suppl 1):4, 2021. Review/Other-Dx 207 intussusception cases To assess whether the monovalent rotavirus vaccine was associated with an increased risk of intussusception as part of the 7-country African evaluation. A total of 207 intussusception cases were identified. The median age of cases was 5.8 months and nearly three-quarters were aged 4-7 months. Median number of days from symptom onset to admission at treatment hospital was 3 (IQR 2-5). Seventy-eight percent (152/195) of cases had been admitted at another hospital before transfer to the treating hospital. Enema reduction was not available; all infants were treated surgically and 55% (114/207) had intestinal resection. The overall case-fatality rate was 30% (62/206). Compared with infants who survived, those who died had longer duration of symptoms before admission to treatment hospital (median 4 vs 3 days; p < 0.01), higher rate of intestinal resection (81% [60/82] vs 44% [64/144], p < 0.001), and from families with lower incomes (i.e., less likely to own a television [p < 0.01] and refrigerator [p < 0.05). 4
28. Lampl BS, Glaab J, Ayyala RS, Kanchi R, Ruzal-Shapiro CB. Is Intussusception a Middle-of-the-Night Emergency?. Pediatric Emergency Care. 35(10):684-686, 2019 Oct. Review/Other-Dx 164 patients To determine whether it would be safe to delay reduction in these patients until normal working hours when more support staff are available. The median time to nonsurgical intervention was higher among patients who ultimately underwent surgery than among those who did not require surgery (17.9 vs 7.0 hours; P < 0.0001). The time to nonsurgical intervention was positively associated with a higher probability of surgical intervention (P = 0.002). 4
29. Williams JL, Woodward C, Royall IR, et al. Outcomes in pediatric patients with documented delays between ileocolic intussusception diagnosis and therapeutic enema attempt: evaluation of reduction efficacy and complication rate. Emerg Radiol 2022;29:953-59. Review/Other-Dx 175 cases of ileocolic intussusception To determine enema success rate and morbidity in patients with documented time delays between intussusception diagnosis and therapeutic enema. There were 175 cases of ileocolic intussusception requiring enema reduction. Successful reduction occurred in 72.2% (13/18) of cases performed within 1 h of diagnosis; 74.3% (78/105) between 1 and3 h; 73.2% (30/41) between 3 and 6 h; and 81.2% (9/11) with greater than 6 h. Need for bowel resection was not associated with short delays between diagnosis and reduction attempts (p = .07). 4
30. Mertiri L, Sher AC, Sammer MB, et al. Association of Time Since Diagnosis of Pediatric Ileocolic Intussusception With Success of Attempted Reduction: Analysis in 1065 Patients. AJR Am J Roentgenol 2024. Review/Other-Dx 1065 patients (793 nontransferred and 272 transferred patients) To identify factors associated with successful image-guided ileocolic intussusception reduction in children, with attention given to the time since diagnosis. The study included 1065 patients (649 male and 416 female patients; mean age, 18.1 months; age range, 2.2-71.0 months; 793 nontransferred and 272 transferred patients). For nontransferred patients, the mean interval between ultrasound diagnosis and the initial reduction attempt was 150.8 minutes; among transferred patients, the mean interval between advanced imaging at an outside facility (when documented) and the reduction attempt was 460.2 minutes (p < .001). Successful reduction occurred in 84.6% and 81.6% of nontransferred and transferred patients, respectively (p = .25). For nontransferred patients, success occurred in 85.6% of attempts performed less than 2 hours after diagnosis versus 84.0% of attempts performed 2 to less than 8 hours after diagnosis (p = .54); the mean interval from diagnosis to attempted reduction was 149.7 and 156.8 minutes for successful and unsuccessful attempts, respectively (p = .53). In multivariable analysis, factors showing independent associations with success were proximal intussusception location (OR = 3.63, p < .001) and absence of high-risk ultrasound findings (OR = 2.57, p < .001); success was not independently associated with age, sex, bloody stools, reduction method used, or time since diagnosis of less than 2 hours (p > .05). For transferred patients, the mean interval from advanced imaging performed at an outside facility to attempted reduction was 463.1 and 440.2 minutes for successful and unsuccessful attempts, respectively (p = .74). 4
31. Strouse PJ, DiPietro MA, Saez F. Transient small-bowel intussusception in children on CT. Pediatr Radiol 2003;33:316-20. Review/Other-Dx 25 pediatric patients with small-bowel intussusception on CT To determine the frequency and significance of small-bowel intussusception identified in children on CT. Twenty-five pediatric patients (16 boys, 9 girls; mean age 11.2 years) were identified with small-bowel intussusception on CT. No patient had a persistent intussusception requiring surgery. Fourteen had limited immediate repeat CT images as part of the same examination, ten of which demonstrated resolution of the CT abnormality. Follow-up CT [ n=13 (6 within 24 h)], ultrasound ( n=3), small-bowel follow-through ( n=4) and surgery ( n=3) showed no intussusception. In four patients with persistent symptoms, underlying pathology was identified requiring treatment (giardiasis, 2; small-bowel inflammation/strictures, 1; abscess and partial small-bowel obstruction after perforated appendicitis, 1). In 21 other patients, direct correlation of symptoms to CT abnormality was absent or questionable, no treatment was required, and there was no clinical or imaging evidence of persistence or recurrence. 4
32. Burns R, Adler M, Benya E, Guthrie B. Fluoroscopy screen time during contrast enema for the evaluation and treatment of intussusception. Pediatric Emergency Care. 30(5):327-30, 2014 May. Observational-Dx 457 included CEs To describe fluoroscopy screen time (FST) for children undergoing contrast enema (CE) for suspected intussusception. The median FST for 457 included CEs was 116 seconds. The median FST for positive CEs (n = 194) was 138 seconds (95% confidence interval [CI], 126-152); for negative CEs (n = 250), 86 seconds (95% CI, 78-102); and for uncertain studies (n = 13), 138 seconds (95% CI, 89-208) (P < 0.01). There was no difference in median FST if symptoms were present 24 hours or less versus longer than 24 hours. There was no difference between contrast types. Median FST for successful reductions was 122 seconds (95% CI, 114-138). In cases of failed reductions, median FST for those undergoing surgery was 277 seconds (95% CI, 195-370) and 175 seconds (95% CI, 128-271) (P < 0.01) for those undergoing delayed repeat CE. The OR for receiving a repeat CE was 1.3 (95% CI, 1.1-1.4; P < 0.01) for every minute of FST. The OR for undergoing surgical reduction was 1.3 (95% CI, 1.2-1.5; P < 0.01) for every minute of FST and 3.7 (95% CI, 2.0-6.9; P < 0.01) for FST longer than 3 minutes. 3
33. Henderson AA, Anupindi SA, Servaes S, et al. Comparison of 2-view abdominal radiographs with ultrasound in children with suspected intussusception. Pediatric Emergency Care. 29(2):145-50, 2013 Feb. Observational-Dx 286 children To compare the utility of AXR with that of the US in children with suspected intussusception. A total of 286 children were included, with mean (SD) age 16.1 (9.1) months; 62.2% were male, and 43.7% were African American. Intussusception was present in 61 subjects (21.3%). Abdominal radiography had sensitivity of 62.3% (95% confidence interval [CI], 50.1%-74.5%) and specificity of 86.7% (95% CI, 82.2%-91.1%), whereas US had a sensitivity of 98.4% (95% CI, 95.2%-100.0%) and specificity of 96.4% (95% CI, 94.0%-98.9%). Ultrasound had a greater negative predictive value (99.5%; 95% CI, 98.6%-100.4%) compared with AXR (89.4%; 95% CI, 85.4%-93.5%). Abdominal radiography had a greater false-positive rate (13.3% vs 3.6%) and greater false-negative rate (37.8% vs 1.6%), compared with US. 3
34. Kim S, Yoon H, Lee MJ, et al. Performance of deep learning-based algorithm for detection of ileocolic intussusception on abdominal radiographs of young children. Scientific Reports. 9(1):19420, 2019 12 19. Observational-Dx 681 children To develop and test the performance of a deep learning-based algorithm to detect ileocolic intussusception using abdominal radiographs of young children. Total 681 children including 242 children in intussusception group were included in the training set and 75 children including 25 children in intussusception group were included in the validation set. The sensitivity of the algorithm was higher compared with that of the radiologists (0.76 vs. 0.46, p = 0.013), while specificity was not different between the algorithm and the radiologists (0.96 vs. 0.92, p = 0.32). 3
35. Kwon G, Ryu J, Oh J, et al. Deep learning algorithms for detecting and visualising intussusception on plain abdominal radiography in children: a retrospective multicenter study. Scientific Reports. 10(1):17582, 2020 10 16. Observational-Dx 1449 images from abdominal X-rays of patients ≤ 6 years diagnosed with intussusception; 9935 images collected from patients without intussusception To verify a deep convolutional neural network (CNN) algorithm to detect intussusception in children using a human-annotated data set of plain abdominal X-rays from affected children. Single Shot MultiBox Detector and ResNet were used for abdominal detection and intussusception classification, respectively. The diagnostic performance of the algorithm was analysed using internal and external validation tests. The internal test values after training with two hospital data sets were 0.946 to 0.971 for the area under the receiver operating characteristic curve (AUC), 0.927 to 0.952 for the highest accuracy, and 0.764 to 0.848 for the highest Youden index. The values from external test using the remaining data set were all lower (P-value < 0.001). The mean values of the internal test with all data sets were 0.935 and 0.743 for the AUC and Youden Index, respectively. 3
36. Patel DM, Loewen JM, Braithwaite KA, Milla SS, Richer EJ. Radiographic findings predictive of irreducibility and surgical resection in ileocolic intussusception. Pediatric Radiology. 50(9):1249-1254, 2020 08. Observational-Dx 182 cases To determine if radiographic findings in ileocolic intussusception can offer prognostic information regarding the outcome of therapeutic air enema and, for those requiring surgical intervention, surgical outcomes and/or complications. Radiographic findings included normal bowel gas pattern in 13%, soft-tissue mass in 26%, paucity of bowel gas in 65%, meniscus sign in 12% and obstruction in 10% of the cases, with 17.5% of patients having more than one finding. In patients with bowel obstruction on radiographs, there was a statistically significant decrease in success of therapeutic enema (83% vs. 21%, P=0.0001), increase in complicated surgical reductions (47% vs. 4%, P=0.0012), and increase in bowel resection (42% vs. 4%, P=0.003) compared to patients with normal bowel gas pattern. 3
37. Tareen F, Mc Laughlin D, Cianci F, et al. Abdominal radiography is not necessary in children with intussusception. Pediatric Surgery International. 32(1):89-92, 2016 Jan. Review/Other-Dx 644 cases of intussusception treated with pneumatic reduction of intussusception (PRI) To investigate the benefit of AR in intussusception by determining diagnostic accuracy and analysing correlation of AR findings with outcome. Six hundred and forty-four cases of intussusception treated with PRI were identified, 412 (64 %) had AR performed and 232 (36 %) did not. 303 (74 %) radiographs had positive findings and 109 (26 %) were normal. The success rate of PRI did not differ between AR positive (82 %) and AR normal (84 %). Occult pneumoperitoneum was not detected in any patient by AR in our cohort. 4
38. Paek SH, Kim DK, Kwak YH, Jung JY, Lee S, Park JW. Effectiveness of the implementation of pediatric intussusception clinical pathway: A pre- and postintervention trial. Medicine. 100(48):e27971, 2021 Dec 03. Experimental-Dx 214 patients This study aimed to evaluate the impact of intussusception clinical pathways (CPs) implementation, including bedside point-of-care ultrasonography, on patient management in a pediatric ED. A total of 233 patients were diagnosed with intussusception. Among them, 19 patients were excluded due to the following reasons. In the pre-protocol period, 5 patients diagnosed with intussusception had incomplete data, while 1 patient was diagnosed with intussusception at another hospital. In the postprotocol period, 6 patients did not receive appropriate care due to high workload in the ED and lack of access to POCUS, resulting in management by a radiologist. In addition, 6 patients were examined with a POCUS before a radiologist confirmed intussusception; however, as the ED physician was not involved, CP was not activated. Finally, 1 patient had a previously confirmed diagnosis from another hospital. The final sample included 214 patients (106 and 108 in the pre- and postprotocol periods). During the 4-year period, a US was conducted in 430 patients with suspected intussusception. Patient characteristics were compared between the periods. There was significant difference between the pre-and postprotocol groups in terms of age, symptom onset-to-ED arrival time and ED triage level, cyclic irritability, and vomiting (Table 1). The median time from symptom onset to ED arrival was 553?min. Over 80% of the patients were classified as ED triage level 3; the most common complaint was abdominal pain. 3
39. Tsou PY, Wang YH, Ma YK, et al. Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: A systematic review and meta-analysis. American Journal of Emergency Medicine. 37(9):1760-1769, 2019 09. Meta-analysis 30 studies It is unclear whether point-of-care ultrasound (POCUS) by emergency medicine physicians is as accurate as radiology-performed ultrasound (RADUS). We aim to summarize the diagnostic accuracy of ultrasonography for intussusception and to compare the performance between POCUS and RADUS. Thirty studies (n = 5249) were included in the meta-analysis. Ultrasonography for intussusception has a sensitivity: 0.98 (95% CI: 0.96-0.98), specificity: 0.98 (95% CI: 0.95-0.99), positive likelihood ratio: 43.8 (95% CI: 18.0-106.7) and negative likelihood ratio: 0.03 (95% CI: 0.02-0.04), with an area under ROC (AUROC) curve of 0.99 (95% CI: 0.98-1.00). Meta-regression suggested no significant difference in the diagnostic accuracy for intussusception between POCUS and RADUS (AUROC: 0.95 vs 1.00, p = 0.128). Good
40. Li XZ, Wang H, Song J, Liu Y, Lin YQ, Sun ZX. Ultrasonographic Diagnosis of Intussusception in Children: A Systematic Review and Meta-Analysis. [Review]. Journal of Ultrasound in Medicine. 40(6):1077-1084, 2021 Jun. Meta-analysis 14 studies (combined n = 2367) To evaluate the diagnostic accuracy of ultrasonography in pediatric intussusception. 14 studies (combined n = 2367) were found eligible for inclusion. Pooled sensitivity and specificity were 0.94 (95% confidence interval: 0.91-0.96) and 0.96 (95% confidence interval: 0.93-0.98), respectively. Inadequate
41. Rahmani E, Amani-Beni R, Hekmatnia Y, et al. Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2023;11:e24. Meta-analysis 37 studies To investigate the diagnostic accuracy of ultrasonography for detection of intussusception and also compare the efficacy of point-of-care ultrasound (POCUS) with radiologist-performed ultrasound (RADUS). A total of 1446 records were retrieved in the initial search of databases. After screening the titles, a total of 344 studies were retrieved for the detailed assessment of full-text. Finally, 37 studies were included in qualitative and quantitative analysis. The pooled sensitivity and specificity of ultrasonography for diagnosis of intussusception were 0.96 (95% CI: 0.95-0.97) and 0.97 (95% CI: 0.97-0.98), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 24.57 (95% CI: 8.26-73.03) and 0.05 (95% CI: 0.04-0.08), respectively. The area under the hierarchical summary receiver operating characteristic (HSROC) curve was 0.989. Mete-regression showed that there is no significant difference between diagnostic performance of POCUS and RADUS (p = 0.06 and rDOR (diagnostic odds ratio) = 4.38 (95% CI: 0.92-20.89)). Good
42. Moore MM, Gee MS, Iyer RS, et al. ACR Appropriateness Criteria® Crohn Disease-Child. J Am Coll Radiol 2022;19:S19-S36. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for Crohn disease in a child. No results stated in abstract. 4
43. Garcia EM, Pietryga JA, Kim DH, et al. ACR Appropriateness Criteria® Hernia. J Am Coll Radiol 2022;19:S329-S40. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for hernia. No results stated in abstract. 4
44. Juvonen P, Lehtimaki T, Eskelinen M, et al. The need for surgery in acute abdominal pain: a randomized study of abdominal computed tomography. In Vivo. 28(3):305-9, 2014 May-Jun. Observational-Dx 203 patients To assess the need for surgical treatment in patients with acute abdominal pain in a prospective randomized study. Diagnostic accuracy improved significantly in the rCT group (p<0.001). The surgeon's assessment of the need for surgery changed more often in the rCT group than in the sCT group (78.7% vs. 46.9%, p=0.002). The confidence to treat operatively increased significantly in the rCT vs. the sCT group (65.6% vs. 40.6%, p=0.028). The rCT was the only independent parameter for the change of the assessment of surgery. 3
45. Chang YJ, Yan DC, Lai JY, et al. Strangulated small bowel obstruction in children. Journal of Pediatric Surgery. 52(8):1313-1317, 2017 Aug. Review/Other-Dx 69 patients To evaluate the clinicoradiological parameters for predicting the presence of a strangulated intestine. Of the 69 patients with SBO, 27 patients had intestinal strangulation and were awarded one point each towards the overall clinical score: intractable continuous abdominal pain, tachycardia, white blood cell count >13,600/mm3, and abdominal distention. Patients with a clinical score =2 combined with the presence of ascites in ultrasound (US) results or with wall thickness and reduced wall contrast enhancement in abdominal computed tomography (CT) scans showed strong evidence for intestinal strangulation. 4
46. Halepota HF, Mateen Khan MA, Shahzad N. Sensitivity and specificity of CT scan in small bowel obstruction among children. JPMA - Journal of the Pakistan Medical Association. 68(5):744-746, 2018 May. Observational-Dx 98 subjects To determine the sensitivity and specificity of computed tomography scan for diagnosing small bowel obstruction among children. Of the 98 subjects, 65(66.0%) were males and 33(34.0%) were females. Overall mean age of the patients was 7.67±4.33 years and mean duration of symptoms was 2.84±1.17 days. Sensitivity, specificity, positive and negative predictive values as well as accuracy of computed tomography scan was 97.4%, 81.8%, 94.9%, 90.0% and 93.9% respectively. 3
47. Chuong AM, Corno L, Beaussier H, et al. Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT. Radiology. 280(1):98-107, 2016 07. Observational-Dx 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients with mechanical SBO To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (? = 0.48) to excellent (? = 0.89; P < .0001). 2
48. Baad M, Delgado J, Dayneka JS, Anupindi SA, Reid JR. Diagnostic performance and role of the contrast enema for low intestinal obstruction in neonates. Pediatric Surgery International. 36(9):1093-1101, 2020 Sep. Observational-Dx 366 CEs To evaluate the diagnostic performance and relationship between clinical characteristics, imaging findings, and final diagnosis for the neonatal contrast enema (CE). Diagnoses included Hirschsprung disease (HD) (15.8%), small left colon syndrome (14.8%), small intestinal atresia/colonic atresia (SIA/CA) (12.6%), meconium ileus (MI) (4.4%), and normal (48.9%). CE had a moderate specificity (87.7%) and low sensitivity (65.5%) for HD; abnormal RSI and serrations showed high specificities (90.3%, 97.4%) but low sensitivities (46.6%, 17.2%). CE showed high specificity (97.4%) and low sensitivity (56.3%) for MI blinded to cystic fibrosis status. Microcolon was specific (96.6%) but not sensitive (68.8%) for MI. CE showed highest PPV (73.1%) (specificity 95.6%, sensitivity 82.6%) for SIA/CA. Microcolon with an abrupt cut-off was specific (99.1%) but not sensitive (41.3%) for atresias. 2
49. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert SE, Cronan JJ. Acute nontraumatic abdominal pain in adult patients: abdominal radiography compared with CT evaluation. Radiology. 2002 Oct;225(1):159-64. Observational-Dx 871 patients had abdominal radiography, and 188 patients had abdominal CT Retrospective study to compare the diagnostic yield of abdominal radiography with that of CT in adult patients presenting to the emergency department with nontraumatic abdominal pain. Interpretation of abdominal radiographs was nonspecific in 588 (68%) of 871 patients, normal in 200 (23%), and abnormal in 83 (10%). The highest sensitivity of abdominal radiography was 90% for intra-abdominal foreign body and 49% for bowel obstruction. Abdominal radiography had 0% sensitivity for appendicitis, pyelonephritis, pancreatitis, and diverticulitis. Sensitivities of abdominal CT were highest for bowel obstruction and urolithiasis at 75% and 68%, respectively. Abdominal radiographs are not sensitive in the evaluation of adult patients presenting to the emergency department with nontraumatic abdominal pain. 3
50. Abbas S, Bissett IP, Parry BR. Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database Syst Rev 2007;2007:CD004651. Review/Other-Dx 12 studies To determine the reliability of water-soluble contrast media and serial abdominal radiographs in predicting the success of conservative treatment in patients admitted with adhesive small bowel obstruction. Furthermore, to determine the efficacy and safety of water-soluble contrast media in reducing the need for surgical intervention and reducing hospital stay in adhesive small bowel obstruction. The appearance of water-soluble contrast in the colon on an abdominal X ray within 24 hours of its administration predicts resolution of an adhesive small bowel obstruction with a pooled sensitivity of 0.97, specificity of 0.96. The area under the curve of the summary ROC curve is 0.98. Six randomised studies dealing with the therapeutic role of gastrografin were included in the review, water-soluble contrast did not reduce the need for surgical intervention (OR 0.81, p = 0.3). Meta-analysis of four of the included studies showed that water-soluble contrast did reduce hospital stay compared with placebo (WMD= - 1.83) P<0.001. 4
51. Esposito F, Vitale V, Noviello D, et al. Ultrasonographic diagnosis of midgut volvulus with malrotation in children. Journal of Pediatric Gastroenterology & Nutrition. 59(6):786-8, 2014 Dec. Review/Other-Dx 34 patients diagnosed as having malrotation or malrotation with volvulus To emphasize the importance of suspecting midgut volvulus as a cause of abdominal pain also beyond infancy, particularly in relation to malrotation, and the relevance of ultrasonographic (US) signs in its diagnosis. In 27 of these 34 patients, midgut volvulus was present; 7 patients had intestinal malrotation. In 2 of 7 (28%) patients with malrotation, SMA and SMV were inverted. Among the patients with volvulus, 2 showed reversed vessel position and 22 patients presented the WS in association with SMA/SMV inversion (22/27, 81%). 4
52. Nguyen HN, Kulkarni M, Jose J, et al. Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta-analysis. Arch Dis Child 2021;106:1171-78. Meta-analysis 2257 Our primary objective was to assess the diagnostic accuracy of abdominal US for the evaluation of midgut malrotation and volvulus in children and adolescents aged 0–21 years compared to the reference standard (diagnosis by surgery, UGI, computed tomography (CT), magnetic resonance (MR), clinical follow-up or any combination). Our secondary objective was to explore heterogeneity among studies by subgroup analyses and meta-regression. Meta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI 89% to 97%) and summary specificity of 100% (95% CI 97% to 100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared with the reference standard. Subgroup analysis and meta-regression revealed better diagnostic accuracy in malrotation not complicated by volvulus, in the neonatal population and enteric fluid administration before US. Good
53. Obeid A, McNeal S, Breland M, Stahl R, Clements RH, Grams J. Internal hernia after laparoscopic Roux-en-Y gastric bypass. Journal of Gastrointestinal Surgery. 18(2):250-5; discussion 255-6, 2014 Feb. Review/Other-Dx 914 patients To determine the impact of mesenteric defect closure and Roux limb position on the rate of internal hernia after laparoscopic Roux-en-Y gastric bypass (LRYGB). Of 914 patients, 663 (72.5 %) had DC vs. 251 (27.5 %) with DnC, and 679 (74.3 %) had an ante-colic vs. 235 (25.7 %) with a retro-colic Roux limb. Forty-six patients (5 %) developed a symptomatic IH. Of these, 25 (3.8 %) were in the DC vs. 21 (8.4 %) in the DnC group (p = 0.005), and 26 (3.8 %) were in the ante-colic vs. 20 (8.5 %) in the retro-colic Roux limb position (p = 0.005). Data from 45 patients were available for further analysis. The most common symptom was chronic postprandial abdominal pain (53.4 %). All patients underwent CT scan consistent with IH in 26 patients (57.5 %), suggestive in 7 (15.6 %), showing small bowel obstruction in 4 (8.9 %), and negative in 8 (17.8 %). 4
54. Lautz TB, Barsness KA. Adhesive small bowel obstruction--acute management and treatment in children. Semin Pediatr Surg 2014;23:349-52. Review/Other-Dx N/A To review the existing literature for infant and pediatric adhesive obstructions with relevant comparisons to the available adult data.To recommend general guidelines for the management of infant and pediatric adhesive obstructions based on the best available evidence. No results in abstract. 4
55. Nguyen ATM, Holland AJA. Paediatric adhesive bowel obstruction: a systematic review. Pediatr Surg Int 2021;37:755-63. Review/Other-Dx N/A To conduct a systematic review to present an overview of the current knowledge on the incidence, aetiology, pathophysiology, clinical presentation, and management of ASBO. No results in abstract. 4
56. Linden AF, Raiji MT, Kohler JE, et al. Evaluation of a water-soluble contrast protocol for nonoperative management of pediatric adhesive small bowel obstruction. J Pediatr Surg 2019;54:184-88. Observational-Tx Not specified Examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (p = 0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2 days (preprotocol) vs 3.6 days (postprotocol) p = 0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. 2
57. Johnson BL, Campagna GA, Hyak JM, et al. The significance of abdominal radiographs with paucity of gas in pediatric adhesive small bowel obstruction. American Journal of Surgery. 220(1):208-213, 2020 07. Review/Other-Dx 207 (6 months-18 years) Management of children with adhesive small bowel obstruction (ASBO) is often based on abdominal radiographs (AXR). Our purpose was to determine the significance of paucity of gas on initial AXR. Of 207 cases, 99 were operative. Initial AXR showed paucity of gas in 41% and gaseous loops in 59%. Paucity was more common in operative patients (49% vs. 32%, p = 0.01). At operation, 71% of patients with paucity had closed loop or high-grade obstruction, compared to 29% of patients with gaseous loops (p = <0.001). 4
58. De Bernardo G, Sordino D, De Chiara C, et al. Management of NEC: Surgical Treatment and Role of Traditional X-ray Versus Ultrasound Imaging, Experience of a Single Centre. Current Pediatric Review. 15(2):125-130, 2019. Review/Other-Dx 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment To describe the results obtained between different approaches to the surgical treatment of Necrotizing Enterocolitis (NEC), according to the extent of the disease, taking into account body weight and gestational age. To analyse the role of traditional X-ray versus US in the various evolutionary phases of NEC, highlighting the strength of the US in the early diagnosis and intervention time of this pathology They were recruited 75 premature infants with NEC symptomatology in phase I-III of Bell staging, who underwent surgical or medical treatment. In infants with a birth weight >1500 g (N=30), laparotomy and necrotic bowel resection has generally been our preferred approach. In 46 patients we practiced a primary anastomosis after resection of an isolated necrotic intestinal segment. In patients with multiple areas of necrosis and dubious intestinal vitality, were performed a 'second-look' scheduled after 24 to 48 hours to re-evaluate the intestine. In the initial phase of necrotizing enterocolitis, when the radiographic examination shows only a specific dilation of the loops, ultrasonography shows more and more specific signs, as wall thickening, alteration of parietal echogenicity, increase in wall perfusion, single or sporadic airborne microbubbles in the thickness of wall sections. 4
59. Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg 2009;44:1072-5; discussion 75-6. Review/Other-Dx 71,808 infants To establish birth weight-based benchmarks for in-hospital mortality in neonates with necrotizing enterocolitis (NEC). Birth weight was divided into 4 categories by 250-g increments. The NEC risk (P < .001) and mortality (P < .001) decreased with higher birth weight category. Necrotizing enterocolitis was associated with a significant odds ratio for death for each category (P < .001). Across groups, the odds ratio for NEC mortality increased with higher birth weight category (category 1 = 1.6 vs category 4 = 9.9; P < .001). 4
60. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011;364:255-64. Review/Other-Tx N/A To review and discuss the development of effective preventive strategies, clear diagnostic criteria need to be used consistently to differentiate between necrotizing enterocolitis and other entities, such as spontaneous intestinal perforation and intestinal injury in term infants. No abstract available. 4
61. Wiland EL, South AP, Kraus SJ, Meinzen-Derr J. Utility of gastrointestinal fluoroscopic studies in detecting stricture after neonatal necrotizing enterocolitis. Journal of Pediatric Gastroenterology & Nutrition. 59(6):789-94, 2014 Dec. Observational-Dx 56 patients To hypothesize that sensitivity and specificity of small bowel follow-through (UGI-SBFT) and contrast enema (CE) were <85% in diagnosing a post-necrotizing enterocolitis (NEC) stricture. A total of 56 patients met inclusion criteria, with 51 UGI-SBFT and 85 CE performed. A total of 25 patients were diagnosed as having a stricture. For small bowel (SB) strictures, CE compared with UGI-SBFT has a higher sensitivity (0.667 vs 0.00) and a similar specificity (0.857 vs 0.833). For SB and/or colonic strictures, CE has a sensitivity of 0.667 and a specificity of 0.951. Strictures were more likely to be found on imaging in symptomatic infants compared with those in asymptomatic infants (28% vs 8%, P = 0.002). 3
62. Burnand KM, Zaparackaite I, Lahiri RP, et al. The value of contrast studies in the evaluation of bowel strictures after necrotising enterocolitis. Pediatric Surgery International. 32(5):465-70, 2016 May. Observational-Dx 116 neonates Strictures of the bowel are a frequent complication post-necrotising enterocolitis (NEC). Contrast studies are routinely performed prior to stoma closure following NEC. The aim of this study was to evaluate the ability of these studies to detect strictures and also directly compare them to operative and histological findings. One hundred and sixteen neonates underwent an emergency laparotomy and 77 had stomas fashioned. Sixty-six patients had a contrast study prior to stoma closure (distal loopogram 18, contrast enema 37, both studies 11). Colonic strictures were reported in 18 patients and small bowel strictures were reported in two patients. Fourteen of these colonic strictures were confirmed at operation and on histology but three colonic strictures were missed on contrast studies; one patient had had both contrast studies and the other two only a distal loopogram. Two small bowel strictures reported were confirmed and an additional small bowel stricture missed on distal loopogram was also detected at the time of operation. The incidence of post-op strictures was 19 out of 68 patients (27.9 %) and 16 (84.2 %) of these strictures were found in the colon. Contrast enemas had a much higher sensitivity for detecting post-NEC colonic strictures than distal loopograms; 93 versus 50 %, respectively; however, they are more likely to give a false positive result and therefore their specificity is lower; 88 versus 95 %, respectively. 4
63. Grant CN, Golden JM, Anselmo DM. Routine contrast enema is not required for all infants prior to ostomy reversal: A 10-year single-center experience. Journal of Pediatric Surgery. 51(7):1138-41, 2016 Jul. Observational-Dx 161 patients To evaluate the patterns of use and the diagnostic yield of preoperative CE in infants at a single children's hospital. To determine the frequency and accuracy of preoperative CE in diagnosing strictures or obstructions, and what,if any, change in management followed. Contrast enemas were performed on 80% of all infants undergoing small bowel ostomy reversal during the study period. Infants with necrotizing enterocolitis (NEC) were more likely to have a CE than those with intestinal atresia (p=0.03) or those with all other diagnoses combined (p=0.03). Nine strictures were identified on CE. Of those, 8 (89%) were in patients with NEC, and only 4 were clinically significant and required operative resection. The overall relevant stricture rate was 2.5%. No patient that underwent ostomy takedown without CE had a stricture diagnosed intraoperatively or an unrecognized stricture that presented clinically after stoma takedown. 3
64. Tam AL, Camberos A, Applebaum H. Surgical decision making in necrotizing enterocolitis and focal intestinal perforation: predictive value of radiologic findings. J Pediatr Surg 2002;37:1688-91. Observational-Dx 80 Given the current controversy over the appropriate surgical management (peritoneal drainage versus exploratory laparotomy) of advanced necrotizing enterocolitis and focal intestinal perforation, the authors examined the predictive value of radiologic findings. For pneumatosis intestinalis, the sensitivity was 44% (n = 27) and specificity, 100% (n = 19). For portal venous gas, the sensitivity was 13% (n = 8) and specificity, 100% (n = 19). The sensitivity and specificity calculated for free air was 52% (n = 23) and 92% (n = 33), respectively. The sensitivity and specificity calculated for a gasless abdomen was 32% (n = 14) and 92% (n = 33), respectively 3
65. Coursey CA, Hollingsworth CL. Author's correction. AJR Am J Roentgenol 2008;191:931. Review/Other-Dx N/A Correction for a previous article. No abstract available. 4
66. Markiet K, Szymanska-Dubowik A, Janczewska I, Domazalska-Popadiuk I, Zawadzka-Kepczynska A, Bianek-Bodzak A. Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS). Pediatric Surgery International. 33(3):335-340, 2017 Mar. Review/Other-Dx 43 neonates To measure the intra- and inter-observer agreement on the radiological signs of NEC according to DAAS to access the feasibility of this scale. Fair-to-good intra-observer agreement was noted for all but one of observers. However, with the wide range in ? values, we found only fair inter-observer agreement detecting signs of NEC according to DAAS. There was a higher intra-group agreement in radiology practitioners, with the highest among experienced pediatric radiologists. 4
67. Chen S, Hu Y, Liu Q, Li X, Wang H, Wang K. Comparison of abdominal radiographs and sonography in prognostic prediction of infants with necrotizing enterocolitis. Pediatric Surgery International. 34(5):535-541, 2018 May. Review/Other-Dx 86 preterm neonates To investigate the comparison of AR and AUS in predicting prognosis in infants with necrotizing enterocolitis. Throughout the study period, 86 preterm neonates were hospitalized with diagnosis of definite NEC. Among these patients, 39 infants (45.3%) required surgical treatment. After adjusting for competing sonographic factors, we identified that thick bowel wall (more than 2.5 mm) (p = 0.001, HR: 1.849), intramural gas (pneumatosis intestinalis) (p = 0.017, HR: 1.265), portal venous gas (p = 0.002, HR: 1.824), and reduced peristalsis (p = 0.021, HR: 1.544) were independent prognostic factors associated with NEC. After adjusting for competing radiographic factors, we identified that free peritoneal gas (p = 0.007, HR: 1.472), portal venous gas (p = 0.012, HR: 1.649), and dilatation and elongation (p = 0.025, HR: 1.327). Moreover, we found that the AUROC for AR logistic model was 0.745 (95% CI 0.629-0.812), which was significant lower than the AUS logistic model (AUROC: 0.857, 95% CI 0.802-0.946) for predicting prognosis of NEC. 4
68. Janssen Lok M, Miyake H, Hock A, Daneman A, Pierro A, Offringa M. Value of abdominal ultrasound in management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatric Surgery International. 34(6):589-612, 2018 Jun. Meta-analysis 15 studies To identify AUS features associated with definite NEC (i.e. Bell stage = II), failed medical treatment, surgery, and death. 15 out of 1215 studies were included. All AUS features had sensitivities below 70% and specificities largely above 80% for diagnosing definite NEC; several AUS features were significantly associated with failed medical treatment and surgery. Substantial heterogeneity, poor reporting quality and uncertain risk of bias were found. Good
69. Cuna AC, Reddy N, Robinson AL, Chan SS. Bowel ultrasound for predicting surgical management of necrotizing enterocolitis: a systematic review and meta-analysis. Pediatric Radiology. 48(5):658-666, 2018 05. Meta-analysis 11 articles (748 patients) To identify bowel US findings associated with surgical management or death in infants with NEC. Of 521 articles reviewed, 11 articles comprising 748 infants were evaluated for quality. Nine of the studies were retrospective and from single-center experiences. Pooled analysis showed that focal fluid collections (OR 17.9, 3.1-103.3), complex ascites (OR 11.3, 4.2-30.0), absent peristalsis (OR 10.7, 1.7-69.0), pneumoperitoneum (OR 9.6, 1.7-56.3), bowel wall echogenicity (OR 8.6, 3.4-21.5), bowel wall thinning (OR 7.11.6-32.3), absent perfusion (OR 7.0, 2.1-23.8), bowel wall thickening (OR 3.9, 2.4-6.1) and dilated bowel (OR 3.5, 1.8-6.8) were associated with surgery or death in NEC. In contrast, portal venous gas (OR 3.0, 0.8-10.6), pneumatosis intestinalis (OR 2.1, 0.9-5.1), increased bowel perfusion (OR 2.6, 0.6-11.1) and simple ascites (OR 0.54, 0.1-2.5) were not associated with surgery or death. Inadequate
70. Le Cacheux C, Daneman A, Pierro A, Tomlinson C, Amirabadi A, Faingold R. Association of new sonographic features with outcome in neonates with necrotizing enterocolitis. Pediatric Radiology. 53(9):1894-1902, 2023 08. Observational-Dx 102 neonates To review a large series of neonates, known to have clinical NEC, to document how frequently the above four sonographic features occur in neonates with necrotizing enterocolitis.To determine whether they are predictive of outcome. We included 102 neonates with clinical necrotizing enterocolitis: 45 in group A and 57 in group B. Neonates in group B were born at a significantly earlier gestational age (median 25 weeks, range 22-38 weeks) and had a significantly lower birth weight (median 715.5 g, range 404-3120 g) than those in group A (median age 32 weeks, range 22-39 weeks, p = 0.003; median weight 1190 g, range 480-4500 g, p = 0.002). The four sonographic features were present in both study groups but with different frequency. More importantly, all four were statistically significantly more frequently present in neonates in group B compared to group A: (i) mesenteric thickening, A = 31 (69%), B = 52 (91%), p = 0.007; (ii) hyperechogenicity of intestinal contents, A = 16 (36%), B = 41 (72%), p = 0.0005; (iii) abnormalities of the abdominal wall, A = 11 (24%), B = 35 (61%), p = 0.0004; and (iv) poor definition of the intestinal wall, A = 7 (16%), B = 25 (44%), p = 0.005. Furthermore, the proportion of neonates with more than two signs was greater in group B compared to group A (Z test, p < 0.0001, 95% CI = 0.22-0.61). 3
71. Kallis MP, Roberts B, Aronowitz D, et al. Utilizing ultrasound in suspected necrotizing enterocolitis with equivocal radiographic findings. BMC Pediatrics. 23(1):134, 2023 03 24. Observational-Dx 54 infants To examine the use of abdominal ultrasound (AUS) as a diagnostic adjunct in the diagnosis of necrotizing enterocolitis (NEC) in cases where abdominal radiography (AXR) is equivocal in order to reduce unnecessary antibiotic use in neonates. Among 54 infants where AXR was equivocal, AUS demonstrated presence of pneumatosis in 22 patients (41%), absence of pneumatosis in 31 patients (57%), and was equivocal in 1 patient. All patients with pneumatosis on AUS were treated for NEC. Of 31 patients without pneumatosis on AUS, 25 patients (78%) were not treated for NEC. Patients without pneumatosis on AUS received a significantly shorter mean duration of antibiotics compared to those with pneumatosis (3.3 days (+/- 4.8 days) vs 12.4 days (+/- 4.7 days)); p < 0.001). Of those patients not treated, none required treatment within 1 week following negative AUS. 3
72. Yikilmaz A, Hall NJ, Daneman A, et al. Prospective evaluation of the impact of sonography on the management and surgical intervention of neonates with necrotizing enterocolitis. Pediatric Surgery International. 30(12):1231-40, 2014 Dec. Observational-Dx 26 infants To evaluate the ability of abdominal US to detect intestinal necrosis in infants with radiographically confirmed NEC. US demonstrated signs of intestinal necrosis in 5 of the 26 patients. All of these five had laparotomy. Intestinal necrosis requiring resection was confirmed in four and the other was found to have NEC but no necrosis was identified. In 21 patients US did not suggest intestinal necrosis. Of these, only one had surgery in whom NEC but no necrosis was identified. The remaining 20 responded to medical treatment for NEC and were assumed not to have had intestinal necrosis based on improvement without surgical intervention. The sensitivity, specificity, positive predictive value and negative predictive values of US for the detection of bowel necrosis were calculated as 100, 95.4, 80.0, and 100%, respectively. 3
73. Urboniene A, Palepsaitis A, Uktveris R, Barauskas V. Doppler flowmetry of the superior mesenteric artery and portal vein: impact for the early prediction of necrotizing enterocolitis in neonates. Pediatric Surgery International. 31(11):1061-6, 2015 Nov. Observational-Dx 62 newborns To evaluate intestinal blood flow in superior mesenteric artery (SMA) and portal vein (PV) in neonates with suspected or confirmed NEC and investigate the prognostic cut-off values to develop NEC. There were 93.5% preterm neonates. 29 patients (46.8%) were diagnosed with NEC and 33 (53.2%) formed a control group. 96.3% NEC patients had RI >0.75 with sensitivity of 96.3% and specificity of 90.9% (OR 260). 88.9% NEC patients had PI >1.85 with sensitivity of 88.9% and specificity of 78.8% (OR 29). Portal Vflow lower than 37 ml/min was present in 89.7% patients with NEC (OR 11.7). 3
74. Benjamin JL, Dennis R, White S, Jr., et al. Improved Diagnostic Sensitivity of Bowel Disease of Prematurity on Contrast-Enhanced Ultrasound. J Ultrasound Med 2020;39:1031-36. Review/Other-Dx N/A Use of contrast-enhanced ultrasound in detection of pediatric bowel disease. No results stated in abstract. 4
75. Measuring Sex, Gender Identity, and Sexual Orientation. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
76. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://edge.sitecorecloud.io/americancoldf5f-acrorgf92a-productioncb02-3650/media/ACR/Files/Clinical/Appropriateness-Criteria/ACR-Appropriateness-Criteria-Radiation-Dose-Assessment-Introduction.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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