Intussusception is the most common abdominal emergency in early childhood, and is often misdiagnosed at initial presentation.

A new study published in Frontiers in Pediatrics aimed to summarize outcomes and misdiagnoses—before and after training junior and senior physicians on using point-of-care ultrasonography (POCUS), in the diagnosis of intussusception, and compared their performance levels.

This was an observational cohort analysis, that included 167 patients with suspected intussusception between January 2017 and December 2019. Misdiagnosis was defined as a finding of negative air reduction or confirmation of diagnosis on ED revisit or admission.

Overall, 130 patients were confirmed to have intussusception by air reduction. Misdiagnosis rate was significantly lower in the post-training patient group than in the pre-training patient group. Moreover, after training, fewer misdiagnoses were made by the junior and senior physicians. In the post-training patient group, the door-to-reduction time and rate of ultrasonography consultation with an expert also decreased significantly. Abdominal pain (80.9%) was the most common symptom, followed by vomiting (58.3%), fever (17.8%), bloody stool (15.4%) and diarrhea (14.2%). Furthermore, after training, the presenting symptoms of intussusception often leading junior physicians to misdiagnosis were diarrhea and fever. 

It was inferred that a brief POCUS training reduces misdiagnosis rates by senior and junior physicians. Combining clinical judgment and POCUS results forms the core principle of evaluation of children with intussusception.

Source: Frontiers in Pediatrics. 2021 Feb 4;9:601492. doi: 10.3389/fped.2021.601492.