Ultrasonographic and clinical predictors of intussusception

J Pediatr. 1998 May;132(5):836-9. doi: 10.1016/s0022-3476(98)70314-2.


Objective: The objective of this study was to determine the positive and negative clinical predictors of intussusception and the correlation of ultrasonography and air enema in establishing this diagnosis.

Study design: This was a prospective descriptive cohort study.

Setting: This study was performed in a tertiary care pediatric emergency department.

Participants: Eighty-eight of 245 candidates were assessed for clinical predictors of intussusception. All 245 cases were examined for correlation between ultrasonography and air enema.

Interventions: A questionnaire, ultrasonography, and air enema were used.

Results: Thirty-five of the 88 patients assessed for clinical predictors were positive for intussusception. Significant positive predictors were right upper quadrant abdominal mass (positive predictive value [PPV] 94%), gross blood in stool (PPV 80%), blood on rectal examination (PPV 78%), the triad of intermittent abdominal pain, vomiting, and right upper quadrant abdominal mass (PPV 93%, p = 0.0001), and the triad with occult or gross blood per rectum (PPV 100%, p = not significant). Significant negative predictors were a combination of > or = 3 of 10 clinically significant negative features (negative predictive value 77%, p = 0.035). Of the total 245 cases, intussusception (as confirmed by doughnut, target, or pseudokidney sign) was ruled out by ultrasonography in 97.4%. Alternate ultrasound findings comprised 27% of negative cases.

Conclusions: Excellent positive predictors of intussusception were identified prospectively. Although no reliable negative predictors were found, patients at low risk may be screened by ultrasonography.

Publication types

  • Comparative Study

MeSH terms

  • Air
  • Child, Preschool
  • Emergency Service, Hospital
  • Enema / methods
  • Female
  • Humans
  • Infant
  • Intussusception / diagnosis*
  • Intussusception / diagnostic imaging*
  • Intussusception / physiopathology
  • Male
  • Predictive Value of Tests
  • Prospective Studies
  • Surveys and Questionnaires
  • Ultrasonography