Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis

Erfan Rahmani; Reza Amani-Beni; Yasaman Hekmatnia; Amirhossein Fakhre Yaseri; Seyed-Amirabbas Ahadiat; Parham Talebi Boroujeni; Moein Kiani; Reza Tavakoli; Seyyed-Ghavam Shafagh; Matin Shirazinia; Setareh Garousi; Mehran Mottahedi; Mohammadreza Arzaghi; Sasan Pourbagher Benam; Amir Rigi; Amir Salmani; Zeynab Abdollahi; Fateme Karimzade Rokni; Tara Nikbakht; Saeme Azizi Hassan Abadi; Roozbeh Roohinezhad; Forough Masheghati; Yas Haririan; Bahar Darouei; Ehsan Fayyazishishavan; Niusha Manoochehri-Arash; Mehrdad Farrokhi

doi:10.22037/aaem.v11i1.1914

Diagnostic Accuracy of Ultrasonography for Detection of Intussusception in Children; a Systematic Review and Meta-Analysis

Arch Acad Emerg Med. 2023 Feb 28;11(1):e24. doi: 10.22037/aaem.v11i1.1914. eCollection 2023.

Authors

Erfan Rahmani¹, Reza Amani-Beni², Yasaman Hekmatnia³, Amirhossein Fakhre Yaseri⁴, Seyed-Amirabbas Ahadiat⁵, Parham Talebi Boroujeni⁶, Moein Kiani⁷, Reza Tavakoli², Seyyed-Ghavam Shafagh⁸, Matin Shirazinia⁹, Setareh Garousi⁹, Mehran Mottahedi⁹, Mohammadreza Arzaghi¹⁰, Sasan Pourbagher Benam¹¹, Amir Rigi¹², Amir Salmani¹³, Zeynab Abdollahi¹⁴, Fateme Karimzade Rokni¹⁵, Tara Nikbakht¹⁶, Saeme Azizi Hassan Abadi¹⁵, Roozbeh Roohinezhad⁸, Forough Masheghati¹⁷, Yas Haririan¹⁸, Bahar Darouei², Ehsan Fayyazishishavan¹⁹, Niusha Manoochehri-Arash²⁰, Mehrdad Farrokhi²¹

Affiliations

¹ School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
² School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
³ Islamic Azad University of Medical Science, Sari, Mazandaran, Iran.
⁴ School of Medicine, Qazvin University of Medical Sciences, Qazvin, lran.
⁵ The Advocate Center for Clinical Research, Ayatollah Yasrebi Hospital, Kashan, Iran.
⁶ Advanced Diagnostic Interventional Radiology Research Center, Tehran University of Medical Science, Tehran, Iran.
⁷ School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
⁸ Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
⁹ Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
¹⁰ Shahid Beheshti University of Medical Sciences, Tehran, Iran.
¹¹ Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran.
¹² Islamic Azad University, Zahedan Branch, Zahedan, Iran.
¹³ Mechanical Engineering, Sharif University of Technology, Tehran, Iran.
¹⁴ Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
¹⁵ Faculty of Medical Sciences, Islamic Azad University of Chalus, Chalus, Mazandaran, Iran.
¹⁶ Islamic Azad University, Tehran Medical Branch, Tehran, Iran.
¹⁷ School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
¹⁸ School of Medicine, Shiraz university of Medical Sciences, Shiraz, Iran.
¹⁹ Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA.
²⁰ Harvard Medical School, Boston, Massachusetts, USA; Division of Endocrinology, Diabetes, Hypertension Brigham and Women's Hospital, Boston, Massachusetts, USA.
²¹ ERIS Research Institute, Tehran, Iran.

Abstract

Introduction: The diagnosis of intussusception can be challenging in children due to the fact that the findings of clinical evaluations are nonspecific and most of the patients present with unclear history. Therefore, in this systematic review and meta-analysis, we aimed 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).

Methods: Two independent reviewers systematically searched different online electronic databases including MEDLINE, Scopus, Web of Science, Google Scholar, Embase, and Cochrane from inception to December 1, 2022 to identify published papers reporting accuracy of ultrasonography for diagnosis of intussusception. The quality assessment of the included studies was investigated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 tool.

Results: 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)).

Conclusion: This meta-analysis shows that ultrasonography has excellent sensitivity, specificity, and accuracy for diagnosis of intussusception in pediatric patients. Moreover, we found that diagnostic performance of POCUS is similar to that of RADUS for diagnosis of intussusception.

Keywords: Diagnostic Imaging; Intussusception; Meta-analysis; Point-of-Care Testing; Ultrasonography.

Publication types

Review