{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:12:01Z","timestamp":1783350721325,"version":"3.54.6"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T00:00:00Z","timestamp":1612396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p><jats:bold>Aim:<\/jats:bold> Intussusception, the most common abdominal emergency in early childhood, is frequently misdiagnosed at initial presentation. The effect of using point-of-care ultrasonography (POCUS) by emergency medicine physicians on pediatric intussusception misdiagnosis rate remains unclear. Here, we summarize outcomes and misdiagnoses before and after training junior and senior physicians on using POCUS for diagnosing intussusception and compared their performance levels.<\/jats:p><jats:p><jats:bold>Materials and Methods:<\/jats:bold> This observational cohort analysis included patients with suspected intussusception who visited a pediatric emergency department (ED) between January 2017 and December 2019. All enrolled patients were evaluated by junior (&amp;lt;10-year experience) or senior attending physicians. Misdiagnosis was defined as a finding of negative air reduction or confirmation of diagnosis on ED revisit or admission. The misdiagnosis rates and outcomes before and after POCUS training for intussusception diagnosis were evaluated and performance of the junior and senior physicians was compared.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Of the 167 enrolled patients, 130 were confirmed to have intussusception by air reduction. Misdiagnosis rate was significantly lower in the post-training patient group after training than in the pre-training patient group (43.7 vs. 12.7%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). After training, fewer misdiagnoses were made by the junior (59.1 vs. 25.9%, <jats:italic>P<\/jats:italic> = 0.003) and senior (31.7 vs. 0%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001) physicians. In the post-training patient group, the door-to-reduction time and rate of ultrasonography consultation with an expert also decreased significantly (118.2 \u00b1 124.5 vs. 198 \u00b1 250.2 min, <jats:italic>P<\/jats:italic> = 0.006). Abdominal pain (80.9%) was the most common symptom of intussusception, followed by vomiting (58.3%), fever (17.8%), bloody stool (15.4%), and diarrhea (14.2%). Even after training, the presenting symptoms of intussusception often leading junior physicians to misdiagnosis were diarrhea and fever.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> A brief POCUS training leads to decreased misdiagnosis rates in both the senior and junior physicians. Junior physicians should increase their awareness regarding diarrhea and fever being the presenting symptoms of intussusception, particularly in early childhood. Combining clinical judgment and POCUS results forms the core principle of the evaluation of children with intussusception.<\/jats:p>","DOI":"10.3389\/fped.2021.601492","type":"journal-article","created":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T05:06:04Z","timestamp":1612415164000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":9,"title":["Point-of-Care Ultrasound May Reduce Misdiagnosis of Pediatric Intussusception"],"prefix":"10.3389","volume":"9","author":[{"given":"Hsiang-Ju","family":"Hsiao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Jan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Chung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Chen","family":"Hsin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sze-Yuen","family":"Yau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Yen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wan-Chak","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia-Wanping","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chyi-Liang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Jung","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1542\/peds.2007-0035","article-title":"Three-year surveillance of intussusception in children in Switzerland","volume":"120","author":"Buettcher","year":"2007","journal-title":"Pediatrics."},{"key":"B2","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1016\/j.pedneo.2013.01.004","article-title":"Nationwide population-based epidemiologic study of childhood and adulthood intussusception in Taiwan","volume":"54","author":"Hsiao","year":"2013","journal-title":"Pediatr Neonatol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1007\/s00247-009-1178-9","article-title":"Intussusception in children: evidence-based diagnosis and treatment","volume":"39","author":"Applegate","year":"2009","journal-title":"Pediatr Radiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1093\/infdis\/jiz621","article-title":"Infectious etiologies of intussusception among children <2 years old in 4 Asian countries","volume":"221","author":"Burnett","year":"2020","journal-title":"J Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1097\/PEC.0b013e31818c2a3e","article-title":"Intussusception","volume":"24","author":"Waseem","year":"2008","journal-title":"Pediatr Emerg Care"},{"key":"B6","doi-asserted-by":"publisher","first-page":"166","DOI":"10.4103\/0189-6725.194665","article-title":"Childhood intussusception: impact of delay in presentation in a developing country","volume":"13","author":"Ogundoyin","year":"2016","journal-title":"Afr J Paediatr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1016\/j.jpedsurg.2012.01.047","article-title":"Predictors of failed enema reduction in childhood intussusception","volume":"47","author":"Fike","year":"2012","journal-title":"J Pediatr Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1016\/j.jpedsurg.2014.09.078","article-title":"Surgical approach to intussusception in older children: influence of lead points","volume":"50","author":"Banapour","year":"2015","journal-title":"J Pediatr Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1016\/j.jpeds.2009.04.006","article-title":"The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians","volume":"155","author":"Morrison","year":"2009","journal-title":"J Pediatr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1016\/j.acra.2017.01.002","article-title":"Comparative effectiveness of imaging modalities for the diagnosis and treatment of intussusception: a critically appraised topic","volume":"24","author":"Carroll","year":"2017","journal-title":"Acad Radiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s00247-009-1353-z","article-title":"Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception","volume":"39","author":"Hryhorczuk","year":"2009","journal-title":"Pediatr Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/s00247-006-0381-1","article-title":"Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam","volume":"37","author":"Justice","year":"2007","journal-title":"Pediatr Radiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"175","DOI":"10.4103\/2319-4170.112739","article-title":"Emergency medicine physicians performed ultrasound for pediatric intussusceptions","volume":"36","author":"Chang","year":"2013","journal-title":"Biomed J"},{"key":"B14","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1186\/s12887-020-02060-6","article-title":"Point-of-care ultrasound may be useful for detecting pediatric intussusception at an early stage","volume":"20","author":"Lee","year":"2020","journal-title":"BMC Pediatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.annemergmed.2008.12.013","article-title":"Emergency ultrasound guidelines","volume":"53","year":"2009","journal-title":"Ann Emerg Med."},{"key":"B16","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.jemermed.2019.06.007","article-title":"Pediatric emergency medicine point-of-care ultrasound for the diagnosis of intussusception","volume":"57","author":"Trigylidas","year":"2019","journal-title":"J Emerg Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/PEC.0000000000001712","article-title":"Point-of-care ultrasound in pediatric diagnostic dilemmas: two atypical presentations of intussusception","volume":"35","author":"Sharma","year":"2019","journal-title":"Pediatr Emerg Care."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1746","DOI":"10.1016\/j.ajem.2019.06.024","article-title":"Point-of-care ultrasound diagnosis of small bowel-small bowel vs. ileocolic intussusception","volume":"37","author":"Park","year":"2019","journal-title":"Am J Emerg Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1136\/ard.2005.037382","article-title":"Interobserver reliability in musculoskeletal ultrasonography: results from a \u201cteach the teachers\u201d rheumatologist course","volume":"65","author":"Naredo","year":"2006","journal-title":"Ann Rheum Dis"},{"key":"B20","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1111\/acem.12653","article-title":"Learning curves in emergency ultrasound education","volume":"22","author":"Blehar","year":"2015","journal-title":"Acad Emerg Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"999","DOI":"10.7863\/ultra.33.6.999","article-title":"Do emergency ultrasound fellowship programs impact emergency medicine residents' ultrasound education?","volume":"33","author":"Adhikari","year":"2014","journal-title":"J Ultrasound Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1760","DOI":"10.1016\/j.ajem.2019.06.006","article-title":"Accuracy of point-of-care ultrasound and radiology-performed ultrasound for intussusception: a systematic review and meta-analysis","volume":"37","author":"Tsou","year":"2019","journal-title":"Am J Emerg Med"},{"key":"B23","doi-asserted-by":"publisher","first-page":"255","DOI":"10.5847\/wjem.j.issn.1920-8642.2014.04.002","article-title":"Emergency bedside ultrasound for the diagnosis of pediatric intussusception: a retrospective review","volume":"5","author":"Lam","year":"2014","journal-title":"World J Emerg Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e90","DOI":"10.1097\/PEC.0000000000001283","article-title":"Point-of-care ultrasound could streamline the emergency department workflow of clinically nonspecific intussusception","volume":"36","author":"Kim","year":"2020","journal-title":"Pediatr Emerg Care"},{"key":"B25","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.annemergmed.2012.02.007","article-title":"Diagnosis of intussusception by physician novice sonographers in the emergency department","volume":"60","author":"Riera","year":"2012","journal-title":"Ann Emerg Med"},{"key":"B26","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1097\/PEC.0b013e3181a792bf","article-title":"Vomiting and apparent life-threatening event","volume":"25","author":"Wohlwend","year":"2009","journal-title":"Pediatr Emerg Care"},{"key":"B27","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/PEC.0000000000001391","article-title":"Fever as a presenting symptom in children evaluated for ileocolic intussusception: the experience of a large tertiary care pediatric hospital","volume":"35","author":"Levinson","year":"2019","journal-title":"Pediatr Emerg Care"},{"key":"B28","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1016\/j.pedneo.2013.01.003","article-title":"Evaluating pediatric intussusception using 24-hour ultrasound","volume":"54","author":"Chang","year":"2013","journal-title":"Pediatr Neonatol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1016\/j.jpeds.2009.11.026","article-title":"Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study","volume":"156","author":"Nylund","year":"2010","journal-title":"J Pediatr"},{"key":"B30","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3393\/ac.2017.33.5.201","article-title":"Salmonella enteritis: a rare cause of adult intussusception","volume":"33","author":"Pham","year":"2017","journal-title":"Ann Coloproctol"},{"key":"B31","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.jpedsurg.2019.07.003","article-title":"Pediatric intussusception in Uganda: differences in management and outcomes with high-income countries","volume":"55","author":"Akello","year":"2020","journal-title":"J Pediatr Surg"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1602054","DOI":"10.1155\/2017\/1602054","article-title":"Associations of adenovirus genotypes in Korean acute gastroenteritis patients with respiratory symptoms and intussusception","volume":"2017","author":"Kim","year":"2017","journal-title":"Biomed Res Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.3390\/jcm9051406","article-title":"Influence of overcrowding in the emergency department on return visit within 72 hours","volume":"9","author":"Kim","year":"2020","journal-title":"J Clin Med"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.601492\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,4]],"date-time":"2021-02-04T05:06:06Z","timestamp":1612415166000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2021.601492\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,4]]},"references-count":33,"alternative-id":["10.3389\/fped.2021.601492"],"URL":"https:\/\/doi.org\/10.3389\/fped.2021.601492","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,4]]},"article-number":"601492"}}