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The Diagnosis of Intussusception

Department of Pediatrics, University of Washington and Children’s Hospital and Regional Medical Center, Seattle, WA

Divya Kapoor, MD

Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT

Richard P. Shugerman, MD

Department of Pediatrics, University of Washington and Children’s Hospital and Regional Medical Center, Seattle, WA

The aims of this study were to identify features in the history, physical examination, and radiologic studies that were associated with the diagnosis of intussusception and to determine if there was a subset of patients being evaluated for intussusception who can be spared from undergoing a contrast enema based on a combination of historical, clinical, and radiographic findings. A retrospective cohort study at a regional children’s hospital emergency department (ED) was conducted. Mean age was 1.2 years among both those with and without intussusception. Predictors of intussusception in the univariate analysis included history of vomiting (P=0.02), abdominal pain (P=0.1), and rectal bleeding (P=0.003); physical examination findings of abdominal mass (P<0.001), abdominal tenderness (P=0.02), and guiac positive stool (P=0.004); and plain radiograph finding of the absence of stool in the ascending colon (P<0.05). We were unable to develop a prediction model that would reliably identify all patients with the diagnosis of intussusception. Previously identified predictors of intussusception remain important in increasing suspicion of this important diagnosis. At this point there is no reliable prediction model that can accurately identify all patients with intussusception. A prospective study may aid in the development of a clinically more useful model.

Clinical Pediatrics, Vol. 43, No. 4, 343-347 (2004)
DOI: 10.1177/000992280404300405


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