{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T10:28:28Z","timestamp":1761560908654,"version":"3.40.5"},"reference-count":17,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1999,6,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To develop a cost- and time-effective algorithm for differentiating hypertrophic pyloric stenosis (HPS) from other medical causes of emesis in infants referred from community-based pediatricians and family practitioners to the imaging department of a tertiary children's care facility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Eighty-nine vomiting infants (22 females, 67 males) between the ages of 11 and 120 days (mean, 43.5 days) had received nothing by mouth for at least 1 hour before the study. Each child was assessed for duration of vomiting, status of body weight, time and volume of last ingestion, and time of last emesis. A #8 French (Sherwood Medical, St Louis, MO) nasogastric feeding tube was placed in the child's stomach. The contents were aspirated and measured to determine likelihood of HPS. An aspirated volume \u22655 mL implicated gastric outlet obstruction, and ultrasonography (US) was performed. If this study was positive for HPS, the patient was referred for surgery. If US was negative, an upper gastrointestinal series (UGI) was performed. An aspirated stomach contents volume &amp;lt;5 mL suggested a medical cause for the emesis, and UGI was performed. Pediatric surgeons with no knowledge of the volume results palpated the abdomens of 73 of 89 infants (82%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Twenty-three of 89 patients (25%) had HPS. The aspirate criteria for HPS had a sensitivity of 91%, a specificity of 88%, and an accuracy of 89%. Of the false-positive studies (total = 8), six were related to recent significant ingestion (within 2 hours of the study), and two were attributable to antral dysmotility. The surgeons palpated the mass in 10 of 19 patients (53%). Sensitivity and specificity were 53% and 93%, respectively. Only 6 of 89 infants (7%) required both US and UGI to determine the etiology of the nonbilious vomiting. By performing the UGI in 66 patients, it was also found that 14% had slow gastric emptying and 79% had gastroesophageal reflux. Eighty-one percent of the gastroesophageal reflux was significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The volumetric method of determining the proper imaging study is cost- and time-effective in the evaluation of the nonbilious vomiting infant for pyloric stenosis. If US was performed initially in all patients referred for imaging, two studies would have been performed in 68 of 89 patients (76%) to define the etiology of the emesis. Because we used the volumetric method, 62 fewer imaging studies were performed, representing a savings of $4464 and 30 hours of physician time. If children are given nothing by mouth for 3 to 4 hours before gastric aspiration, the specificity of the volumetric method improves to 94%, and the accuracy improves to 96%.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.103.6.1198","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:45:45Z","timestamp":1092440745000},"page":"1198-1202","source":"Crossref","is-referenced-by-count":26,"title":["Cost-effective Imaging Approach to the Nonbilious Vomiting Infant"],"prefix":"10.1542","volume":"103","author":[{"given":"Gerald A.","family":"Mandell","sequence":"first","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip J.","family":"Wolfson","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. Stanton","family":"Adkins","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar A.","family":"Caro","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian","family":"Cassell","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark S.","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie E.","family":"Grissom","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George W.","family":"Gross","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. Theodore","family":"Harcke","sequence":"additional","affiliation":[{"name":"From the Departments of Medical Imaging and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aviva L.","family":"Katz","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven G.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Noseworthy","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marshall Z.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Pediatric Surgery, Alfred I. duPont Hospital for Children, Wilmington, Delaware."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[1999,6,1]]},"reference":[{"key":"2021121002533248400_B1","first-page":"881","article-title":"Infantile hypertrophic pyloric stenosis.","volume":"58","author":"Prowser","year":"1965","journal-title":"Surgery."},{"key":"2021121002533248400_B2","doi-asserted-by":"crossref","first-page":"905","DOI":"10.2214\/ajr.163.4.8092033","article-title":"Diagnosis of hypertrophic pyloric stenosis: value of sonography when used in conjunction with clinical findings and laboratory data.","volume":"163","author":"Van der Schouw","year":"1994","journal-title":"AJR."},{"key":"2021121002533248400_B3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1542\/peds.81.2.213","article-title":"Patterns in the diagnosis of hypertrophic pyloric stenosis.","volume":"1","author":"Breaux","year":"1988","journal-title":"Pediatrics."},{"key":"2021121002533248400_B4","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/S0022-3476(67)80233-6","article-title":"The radiographic diagnosis of congenital hypertrophic pyloric stenosis.","volume":"71","author":"Shuman","year":"1967","journal-title":"J Pediatr."},{"key":"2021121002533248400_B5","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/S0022-3468(98)90186-5","article-title":"The role of ultrasonography in the diagnosis of pyloric stenosis: a decision analysis.","volume":"33","author":"Olson","year":"1998","journal-title":"J Pediatr Surg."},{"key":"2021121002533248400_B6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.2214\/ajr.140.2.221","article-title":"Muscle thickness in hypertrophic pyloric stenosis: sonographic determination.","volume":"140","author":"Blumhagen","year":"1983","journal-title":"AJR."},{"key":"2021121002533248400_B7","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S0022-3468(84)80371-1","article-title":"Pyloric stenosis: diagnosis by real-time sonography, the pyloric muscle length method.","volume":"19","author":"Tunnell","year":"1984","journal-title":"J Pediatr Surg."},{"key":"2021121002533248400_B8","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1007\/BF02456287","article-title":"The improved ultrasound diagnosis of hypertrophic pyloric stenosis.","volume":"16","author":"Stunden","year":"1986","journal-title":"Pediatr Radiol."},{"key":"2021121002533248400_B9","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1148\/radiology.193.3.7972822","article-title":"Hypertrophic pyloric stenosis in the infant without a palpable olive. Accuracy of sonographic diagnosis.","volume":"193","author":"Hernanz-Schulman","year":"1994","journal-title":"Radiology."},{"key":"2021121002533248400_B10","doi-asserted-by":"crossref","first-page":"1604","DOI":"10.1016\/S0022-3468(97)90463-2","article-title":"Cost-effectiveness in diagnosing infantile hypertrophic pyloric stenosis.","volume":"32","author":"Hulka","year":"1997","journal-title":"J Pediatr Surg."},{"key":"2021121002533248400_B11","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1148\/radiology.177.3.2243984","article-title":"Hypertrophic pyloric stenosis: volumetric measurement of nasogastric aspirate to determine the imaging modality.","volume":"177","author":"Finkelstein","year":"1990","journal-title":"Radiology."},{"key":"2021121002533248400_B12"},{"key":"2021121002533248400_B13","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1016\/S0022-3468(96)90145-1","article-title":"Pyloric stenosis in the age of ultrasonography: fading skills, better patients?","volume":"31","author":"Chen","year":"1996","journal-title":"J Pediatr Surg."},{"key":"2021121002533248400_B14","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1136\/bmj.306.6877.553","article-title":"Clinical diagnosis of pyloric stenosis: a declining art.","volume":"306","author":"Macdessi","year":"1993","journal-title":"Br Med J."},{"key":"2021121002533248400_B15","first-page":"312","article-title":"Congenital hypertrophic pyloric stenosis: surgical experience.","volume":"50","author":"Gibbs","year":"1975","journal-title":"Mayo Clin Proc."},{"key":"2021121002533248400_B16"},{"key":"2021121002533248400_B17","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/S0022-3468(96)90032-9","article-title":"Changing patterns of diagnosis and treatment of infantile hypertrophic pyloric stenosis: a clinical audit of 303 patients.","volume":"31","author":"Poon","year":"1996","journal-title":"J Pediatr Surg"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1198\/844361\/1198.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/103\/6\/1198\/844361\/1198.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,29]],"date-time":"2023-04-29T05:31:59Z","timestamp":1682746319000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/103\/6\/1198\/62336\/Cost-effective-Imaging-Approach-to-the-Nonbilious"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1999,6,1]]},"references-count":17,"journal-issue":{"issue":"6","published-online":{"date-parts":[[1999,6,1]]},"published-print":{"date-parts":[[1999,6,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.103.6.1198","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"type":"electronic","value":"1098-4275"},{"type":"print","value":"0031-4005"}],"subject":[],"published":{"date-parts":[[1999,6,1]]}}}