Vomiting, Pyloric Mass, and Point-of-Care Ultrasound: Diagnostic Test Accuracy for Hypertrophic Pyloric Stenosis-A Meta-Analysis.

Autor: Hom J; Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York; Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York. Electronic address: jeffrey.hom@stonybrookmedicine.edu., Lam SHF; Department of Emergency Medicine, Sutter Medical Center, Sacramento, California., Delaney KM; Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York., Koos JA; Health Science Library, Stony Brook University, Stony Brook, New York., Kunkov S; Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York; Department of Emergency Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2023 Nov; Vol. 65 (5), pp. e427-e431. Date of Electronic Publication: 2023 Jun 21.
DOI: 10.1016/j.jemermed.2023.06.001
Abstrakt: Background: Hypertrophic pyloric stenosis is a common cause of nonbilious vomiting in infants younger than 6 months. Its history, physical examination, and point-of-care ultrasound (POCUS) have not been compared for their diagnostic test accuracy.
Objective: The aim of this systematic review was to quantify and compare the diagnostic test accuracy of a history of vomiting, a pyloric mass on palpation, and POCUS.
Methods: We performed three searches of the literature from 1977 to March 2022. We evaluated bias using the QUADAS-2 (Quality Assessment Tool for Diagnostic Accuracy-2) tool. We performed a bivariate analysis.
Results: From 5369 citations, we identified 14 studies meeting our inclusion criteria. We quantified three diagnostic elements: POCUS, a pyloric mass on palpation, and vomiting. We identified five studies that analyzed POCUS, which included 329 patients. POCUS had a sensitivity of 97.7% (95% confidence interval (CI) 93.1-99.3%) and a specificity of 94.1% (95% CI 88.7-97.1%) for detecting pyloric stenosis. We identified six studies that analyzed the presence of a pyloric mass, which included 628 patients. The palpation of a pyloric mass had a sensitivity of 73.5% (95% CI 62.6-82.1%) and a specificity of 97.5% (95% CI 93.8-99.0%). We identified four studies that analyzed vomiting, which included 355 patients. Vomiting had a sensitivity of 91.3% (95% CI 82.1-96.0) and a specificity of 60.8% (95% CI 8.5-96.3). Both POCUS and palpation of a pyloric mass had a high positive likelihood ratio (LR+: 17 and 33, respectively). The LR+ for vomiting was 5.0.
Conclusions: Both POCUS and palpable mass had high specificity and positive LR, whereas vomiting provided the lowest diagnostic test measures.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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