Abstract
OBJECTIVES: To assess the accuracy of clinical examination as compared with ultrasound imaging in the diagnosis of infantile hypertrophic pyloric stenosis. Duration of hospital stay, time between admission and surgery, and financial implications were also considered. DESIGN: A prospective study of patients referred to the surgical team with a possible diagnosis of pyloric stenosis from May 1993 to January 1995. SETTING: Neonatal and paediatric surgical wards and imaging department of a paediatric teaching hospital. SUBJECTS: 116 patients referred to the surgical team with a possible diagnosis of pyloric stenosis. RESULTS: 75 patients in this study had pyloric stenosis (64.6%). Clinical examination had a sensitivity of 72%, specificity of 97%, with a positive and negative predictive value of 98% and 61% respectively. There were 16 diagnostic errors (one false positive and 15 false negative). Ultrasound imaging had a sensitivity of 97%, specificity of 100%, with a positive and negative predictive value of 100% and 98% respectively. There was one diagnostic error (one false negative). Eight patients required repeat scans for confirmation of the diagnosis. On review of the initial scans in these patients, seven were noted to have inaccurate measurements due to poor technique. The average time between repeated scans was 28.2 hours. Ultrasound imaging cost 13.90 pounds per scan and initiated a change in management only in the clinically false negative group at a cost of 52 pounds per patient. The average duration of hospital stay was 3.1 days and the mean time between admission and surgery was 19.2 hours. The total cost for treatment of a patient with pyloric stenosis was 1602 pounds. CONCLUSION: Ultrasound imaging should be reserved for those cases where clinical examination is negative and should be carried out by sonographers who see enough cases to maintain their expertise.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Carver R. A., Okorie M., Steiner G. M., Dickson J. A. Infantile hypertrophic pyloric stenosis--diagnosis from the pyloric muscle index. Clin Radiol. 1987 Nov;38(6):625–627. doi: 10.1016/s0009-9260(87)80342-2. [DOI] [PubMed] [Google Scholar]
- Eriksen C. A., Anders C. J. Audit of results of operations for infantile pyloric stenosis in a district general hospital. Arch Dis Child. 1991 Jan;66(1):130–133. doi: 10.1136/adc.66.1.130. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Forman H. P., Leonidas J. C., Kronfeld G. D. A rational approach to the diagnosis of hypertrophic pyloric stenosis: do the results match the claims? J Pediatr Surg. 1990 Feb;25(2):262–266. doi: 10.1016/0022-3468(90)90436-d. [DOI] [PubMed] [Google Scholar]
- Haller J. O., Cohen H. L. Hypertrophic pyloric stenosis: diagnosis using US. Radiology. 1986 Nov;161(2):335–339. doi: 10.1148/radiology.161.2.3532185. [DOI] [PubMed] [Google Scholar]
- Khamapirad T., Athey P. A. Ultrasound diagnosis of hypertrophic pyloric stenosis. J Pediatr. 1983 Jan;102(1):23–26. doi: 10.1016/s0022-3476(83)80280-7. [DOI] [PubMed] [Google Scholar]
- Macdessi J., Oates R. K. Clinical diagnosis of pyloric stenosis: a declining art. BMJ. 1993 Feb 27;306(6877):553–555. doi: 10.1136/bmj.306.6877.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Neilson D., Hollman A. S. The ultrasonic diagnosis of infantile hypertrophic pyloric stenosis: technique and accuracy. Clin Radiol. 1994 Apr;49(4):246–247. doi: 10.1016/s0009-9260(05)81849-5. [DOI] [PubMed] [Google Scholar]
- Teele R. L., Smith E. H. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977 May 19;296(20):1149–1150. doi: 10.1056/NEJM197705192962006. [DOI] [PubMed] [Google Scholar]
- Wilson D. A., Vanhoutte J. J. The reliable sonographic diagnosis of hypertrophic pyloric stenosis. J Clin Ultrasound. 1984 May;12(4):201–204. doi: 10.1002/jcu.1870120406. [DOI] [PubMed] [Google Scholar]