{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T14:07:10Z","timestamp":1779890830183,"version":"3.53.1"},"reference-count":26,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032892","name":"VinUniversity","doi-asserted-by":"crossref","award":["IP400083"],"award-info":[{"award-number":["IP400083"]}],"id":[{"id":"10.13039\/100032892","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,14]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess the diagnostic accuracy of contrast enema for Hirschsprung disease in children when preoperative rectal suction biopsy was unavailable and to examine age-related diagnostic performance and the utility of individual radiographic signs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective diagnostic accuracy study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A high-volume tertiary paediatric surgical centre in Hanoi, Vietnam, during a period of COVID-19 related service disruption from May 2020 to October 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>354 consecutive children aged 0 to under 16 years who underwent contrast enema for suspected Hirschsprung disease. Final diagnosis was established by intraoperative frozen section and postoperative histopathology for operated patients and by clinical follow-up for non-operated patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome was diagnostic accuracy of contrast enema versus the reference standard, expressed as sensitivity, specificity, positive predictive value and negative predictive value with 95% CIs. Secondary outcomes were age-stratified accuracy and the performance of individual radiographic signs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 354 children, contrast enema yielded 131 true positives, 19 false positives, 20 false negatives and 184 true negatives. Overall sensitivity was 86.75% (95% CI 80.43 to 91.26), specificity 90.64% (95% CI 85.85 to 93.93), positive predictive value 87.33% (95% CI 81.06 to 91.74) and negative predictive value 90.20% (95% CI 85.34 to 93.56). Sensitivity was higher in children aged 1\u2009month or less than in those older than 1\u2009month, 96.00% vs 75.71%, whereas specificity was lower, 80.00% vs 97.67%. Of the individual radiographic signs, the inverted rectosigmoid index was the most sensitive, while the irregular mucosal pattern was the most specific.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Contrast enema showed moderate to high diagnostic accuracy for Hirschsprung disease in this biopsy-constrained setting and may be useful as a triage tool within a limited diagnostic pathway. However, its false negative rate indicates that it should not be used as a standalone rule-out test when histological confirmation is available.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111494","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T12:00:20Z","timestamp":1779883220000},"page":"e111494","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["What is the diagnostic accuracy of contrast enema for Hirschsprung disease during COVID-19 service disruption in Vietnam? A retrospective study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2597-2984","authenticated-orcid":false,"given":"Quynh Anh","family":"Tran","sequence":"first","affiliation":[{"name":"Department of Paediatric Surgery, Vietnam National Children\u2019s Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hien Duy","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Vietnam National Children\u2019s Hospital, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4126-1015","authenticated-orcid":false,"given":"Trang Thu","family":"Dang","sequence":"additional","affiliation":[{"name":"College of Health Sciences, VinUniversity, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linh Vu Thuy","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Health Sciences, VinUniversity, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dung Boi","family":"Ly","sequence":"additional","affiliation":[{"name":"College of Health Sciences, VinUniversity, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nhung Thi","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Health Sciences, VinUniversity, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoang Viet","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Health Sciences, VinUniversity, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8413-1910","authenticated-orcid":false,"given":"Quang Thanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Paediatric Surgery, Vietnam National Children\u2019s Hospital, Hanoi, Vietnam"},{"name":"College of Health Sciences, VinUniversity, 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