intussusception
This procespective study looks for a prediction model that can be used to determine whether or not a patient requires further work up for intussusception. The study notes that prior models have utitlized Xray as one of their factors to evaluate intussusception, and this group wanted a model that used only history and physical exam findings. Classic findings in intussusception (colicky abdominal pain, vomiting, and bloody stools) are unreliable- I had an attending in residency who always said, "'classic" is Latin for 'about 20-30%'"- and this holds true in intussusception.
This study included 83 children under 6 years old who presented with symptoms concerning for intussusception (as per the discretion of the treating physician). 29 patients were found to have intussusception (35%). They found 4 predictors of intussusception; these included RUQ tenderness (aOR 8.2), absence of diarrhea (aOR 8.0), absence of fever (aOR 4.4) and intermittent pain or irritability (aOR 3.4). They state that if you have none of these, you can effectively rule out intussusception, but if you have 1 or more (and already have clinical suspicion for intussusception), you need to work them up further.
Bottom Line: I don't think this adds a whole lot, to be honest. There aren't too many children in whom I'm considering intussusception that don't already have intermittent pain/irritability. I am surprised by the high adjusted odds ratios of both RUQ tenderness and absence of diarrhea, so the presence of these findings in a kid I'm already considering intussusception will heighten my suspicion. When in doubt, just order the ultrasound.
This study included 83 children under 6 years old who presented with symptoms concerning for intussusception (as per the discretion of the treating physician). 29 patients were found to have intussusception (35%). They found 4 predictors of intussusception; these included RUQ tenderness (aOR 8.2), absence of diarrhea (aOR 8.0), absence of fever (aOR 4.4) and intermittent pain or irritability (aOR 3.4). They state that if you have none of these, you can effectively rule out intussusception, but if you have 1 or more (and already have clinical suspicion for intussusception), you need to work them up further.
Bottom Line: I don't think this adds a whole lot, to be honest. There aren't too many children in whom I'm considering intussusception that don't already have intermittent pain/irritability. I am surprised by the high adjusted odds ratios of both RUQ tenderness and absence of diarrhea, so the presence of these findings in a kid I'm already considering intussusception will heighten my suspicion. When in doubt, just order the ultrasound.
