Pediatric emergency department physicians can predict likelihood of intussusception

Pediatric emergency department (ED) physicians usually can accurately predict the likelihood of an intussusception diagnosis on the basis of history and physical examination, a new study shows. They are even more accurate in identifying patients who are at low risk than in identifying those at high risk.

The prospective cohort study included 308 children aged 1 month to 6 years (median age, 21.1 months) who were brought to an urban, tertiary care pediatric ED with possible intussusception, determined by the treating physician. Investigators asked ED physicians to indicate what they believed was the likelihood of each child's having intussusception on the basis of patient history and physical examination before any diagnostic imaging was performed.

According to ED physicians, in about two-thirds of patients, the likelihood of having intussusception was 10% or lower, in one-quarter the likelihood was 11% to 50%, and in only 8% of patients was the likelihood of intussusception higher than 50%. Overall, physicians assessed 80% of patients as at lower risk (defined as ≤25% likelihood) and 20% at higher risk (>25% likelihood) of intussusception.

The study also found that physicians were significantly more likely to consider children with lethargy at home and bloody stool to be at higher risk for intussusception than children without these clinical symptoms (Weihmiller SN, et al. Pediatr Emer Care. 2012;28[2]:136-140).

Commentary

It is reassuring to know that a good history and physical exam will usually lead you to a correct diagnosis of intussusception. But it's also good to remember that for this diagnosis, the history and physical can lead you astray. In the 247 children whom physicians thought had a low likelihood of intussusception, there were 16 cases (6.4%), or more than 1 in 20. We should trust our diagnostic skills but respect this potentially serious diagnosis and use confirmatory testing wisely. -Michael Burke, MD

DR BURKE, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a contributing editor for Contemporary Pediatrics. He has nothing to disclose in regard to affiliations with or financial interests in any organization that may have an interest in any part of this article.