ICT Role in 21st Century Education & its Challenges.pptx
Saem oral edu invagination (final)
1. Evaluation of bedside sonography
performed by emergency
physicians to detect
intussusception in children in the
emergency department
Tonson LaTour A1, Desjardins MP2, Gravel J2
1 Hôpitaux Universitaires de Genève, Geneva, Switzerland
2 CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
2. All co-investigators have documented no
financial relationships to disclose or Conflicts of
Interest (COIs) to resolve
Disclosure
4. Study objective
• Evaluate POCUS by emergency physicians
with various levels of experience to detect
intussusception in children
5. Method
• Study design:
• A prospective cohort study
• Setting:
• A tertiary care pediatric ED
• CHU Sainte-Justine
• 2015-2018
6. Method
• Children
• A convenience sample
• Aged 0-5 years old
• Suspicion of intussusception according to the ED physician
• Request for a formal ultrasound
• Physicians
• Experienced in PEM
• Various training in POCUS
7. Method
• Intervention:
• 30 minutes theoretical training
• 30 minutes practical training
• POCUS on 3 patients
• Use linear probe
• 4 quadrants
16. Conclusion
• Excellent sensitivity and specificity of POCUS for
intussusception in children when performed by multiple
emergency physicians with variable POCUS
experience.
18. Baseline demographics of study participants
Patient who had POCUS
n= 131 (%)
Patient without
POCUS
N= 107 (%)
P-value*
Median age in month 18 (10-34) 27 (14-38) 0.03
Sex male 79 (0.60) 66 (0.62) 0.83
Abdominal pain 119 (0.91) 102 (0.95) 0.23
Unusual crying 110 (0.84) 90 (0.84) 0.34
Abdominal mass 12 (0.09) 2 (0.02) 0.02
Rectal bleeding 32 (0.24) 15 (0.24) 0.13
Past history of intussusception 12 (0.09) 7 (0.07) 0.49
Final Diagnosis
Intussusception
Gastro-enteritis
Constipation
Abdominal pain
Mesenteric adenitis
Other
45 (0.34)
20 (0.15)
27 (0.21)
12 (0.09)
11 (0.08)
16 (0.12)
30 (0.28)
20 (0.19)
13 (0.12)
16 (0.15)
6 (0.06)
22 (0.20)
0.24
19. POCUS by emergency physicians in comparison to
final outcome according to their experience
Final diagnosis
Intussusception No intussusception Total
Novice MD Intussusception 24 1 25
No intussusception 1 35 36
Inconclusive 5 22 27
Total 30 58 88
Experienced Intussusception 15 2 17
No intussusception 0 20 20
Inconclusive 0 6 6
Total 15 28 43
OR: 3.6
0.43-30.5
20. Pre and post test probability (from 0 to 1.00)
for children with intussusception
0
10
20
30
40
50
60
70
80
90
100
Pre Post
21. Pre and post test probability (from 0 to 1.00)
for children without intussusception
0
10
20
30
40
50
60
70
80
90
100
Pre Post
Notes de l'éditeur
Thank you
We have no conflict of interest
We all know that Intussusception is a medical emergency and that the diagnosis is usually made in radiology by ultrasound.
Two previous studies suggested that POCUS could be used to help ED physicians diagnose intussusception.
However, these studies were small and the total number of cases was 25
The primary objective of this study was to Evaluate the ability of emergency physicians with various levels of POCUS experience to detect intussusception with bedside ultrasound among children
This was a prospective cohort study conducted at Sainte-Justine Hospital. A tertiary care pediatric hospital. Recruitment occurred during 3 years
There was two level of participants
First, patients were a convenience sample of children aged 0-5 years old for whom the treating physicians requested a formal ultrasound from radiology for a possible intussusception.
Physicians were also considered as participants because we evaluated their performance. To be included, a physician had to have minimal experience in POCUS and received a 1-hour specific training on intussusception
This training included a 30 minutes power point presentation on POCUS and intussusception. Then, physicians practice the technique on 3 children.
The ultrasound was performed using a linear probe.
And we evaluated the 4 quadrants starting on the right lower quadrants.
The primary outcome was intussusception confirmed at radiology or surgery.
All families provided verbal consent for the study
During the study period, a total of 238 children had a suspicion of intussusception.
Of these, 107 were seen by a physician not trained in Intussusception POCUS so they were excluded leading to 131 included children.
Of these, there were 45 intussusception.
A total of 24 physicians evaluated at least one patient.
This is the table with the primary results.
As mentioned, there were 45 intussusceptions and 86 control
The physicians identified 39 of 45 intussusceptions, they wrongly said there was non intussusception in 1 children and it was inconclusive in 5.
This leads to a sensitivity of at least 87%
Of the 86 patients without intussusception, it was inconclusive or negative in 83 children for a specificity of 97%
If you remove the 33 patients for whom it was inconclusive, the sensitivity and specificity were of 98 and 94%
There are limitations to our study.
First, it was conducted in a single setting. Physicians in this setting have an excellent experience in PEM.
The most important limitation is the use of a convenience sample. It is possible that physicians only included children for whom they were more sure about their POCUS evaluation. We don’t think this happened but we cannot be 100% sure.
Finally, the sample size was rather small but this is larger than the previous studies including 12 and 13 cases.
IN conclusion, our study demonstrated an Excellent sensitivity and specificity of POCUS for intussusception in children when performed by multiple emergency physicians with variable POCUS experience
I will now be happy to take your questions and thank you for your attention
