Pediatrics

Abstracts

124 - A Systematic Review of Diagnostic Test Accuracy for Point-of-Care Ultrasound for Hypertrophic Pyloric Stenosis

Presenting Author(s)

• 

  Jeffrey Hom, MD, MPH

  Stony Brook Medicine / Pediatrics & Emergency Medicine

  Disclosure Relationship(s): Nothing to disclose

Moderator(s)

• 

  Carolyn Holland, MD, MEd

  University of Florida

Background: Hypertrophic pyloric stenosis (HPS) is a common surgical cause of vomiting in infants less than 12 weeks of life.  There has been a trend that early diagnosis is facilitated by ultrasound, compared to history and physical exam.  This systematic review assessed the accuracy of point-of-care ultrasound (POCUS), when performed by surgeons and pediatric emergency physicians.  

Methods: We conducted a search of electronic databases, PubMed, EMBASE, Cochrane Library, Web of Science, and CINHAL.  The search strategy included concept terms relating to HPS, diagnosis, and pediatrics.  We placed a language restriction to English.  We reviewed studies published between 1905 and October 2018. Statistics were calculated with [R], via package, mada, version 0.5.7.  Cells with zero in the 2x2 tables included a 0.5 correction.  This study was registered with PROSPERO, registration number - CRD42018114476.

Results: There were 5,339 records identified.  Of which, five studies were identified that met the study question.  Four studies had complete data.  We contacted the author of the remaining study for unpublished data.   There were 200 patient encounters, with 218 POCUS performed.  All studies did not have any false positive or false negative.

Study                   TP   TN     Sensitivity      Specificity           LR(+)                LR(-)              DOR
                                                (95%CI)         (95%CI)        (95%CI)           (95%CI)          (95%CI)
Sivitz, 2013          10   57            95.5%            99.1%             110                 0.05              2415
                                            (67.9-99.5)    (92.3-99.9)     (7.0-1754)    (0.003-0.69)   (45-128564)
McVay, 2009        66    5             99.3%            91.7%            11.9               0.008              1463
                                            (93.2-99.9)    (51.7-99.1)     (0.84-169)    (0.001-0.13)     (26-81102)
Copeland, 2009   25   7              98.1%           93.8%            15.7               0.021                765
                                            (84.0-99.8)    (59.8-99.3)       (1.1-230)     (0.001-0.32)     (13-41917)
Boneti, 2008        28    2             98.3%           83.3%              5.9               0.021                285
                                            (85.4-99.8)    (31.0-98.2)       (0.47-74)     (0.001-0.34)       (4-17678)

where: TP: true positive TN: true negative; CI: confidence interval; LR(+): positive likelihood ratio; LR(-): negative likelihood ratio; DOR: diagnostic odds ratio

Summary Statistics (95% CI)
Sensitivity = 98.2% (93.0-99.5)
Specificity = 94.9% (81.5-98.8)
Diagnostic odds ratio = 965 (128-7170)
Area under the curve: 0.975

Conclusion: This review suggests that non-radiologist can perform POCUS for HPS with high levels of accuracy.  This review is limited to one institution accounting for 2/3 of study population.

Upon completion of this session, participants should be able to:

• Upon completion, participants will be able to appraise the literature about point-of-care ultrasound to diagnose hypertrophic pyloric stenosis.
• Upon completion, participants will be able to discuss the literature about point-of-care ultrasound to diagnose hypertrophic pyloric stenosis.
• Upon completion, participants will be able to recommend point-of-care ultrasound as a viable first option to diagnose hypertrophic pyloric stenosis.