Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta-analysis.
Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta-analysis.
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DOI：
10.1136/archdischild-2020-321082
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发表时间：
2021-12
影响因子：
5.2
通讯作者：
Pammi M
中科院分区：
文献类型：
--
作者：
Nguyen HN;Kulkarni M;Jose J;Sisson A;Brandt ML;Sammer MBK;Pammi M
尽管超声（US）具有优势，但上消化道造影（UGI）仍然是诊断儿童中肠旋转不良和扭转的一线诊断方法。评价超声诊断0-21岁儿童和青少年旋转不良伴或不伴扭转的准确性，并与参考标准（通过手术、UGI、CT、MRI和临床随访单独或组合诊断）进行比较。我们于2019年10月检索了电子数据库Ovid-MEDLINE、Embase、Scopus、CINAHL和科克伦图书馆，并于2020年8月18日更新。评价超声诊断儿童（0-21岁）中肠旋转不良伴或不伴扭转的诊断性能的研究。数据由2位作者独立提取，并使用双变量模型进行合成。对17项队列或横断面研究和2257名受试者进行的荟萃分析估计，与参考标准相比，使用超声诊断旋转不良伴或不伴中肠扭转的总体敏感性为94%（95% CI，89%-97%），总体特异性为100%（95% CI，97%-100%）（中等确定性证据）。亚组分析和荟萃回归分析显示，在新生儿人群中，超声检查前给予肠液对未并发扭转的旋转不良的诊断准确性更高。中等确定性证据表明诊断准确性极佳，再加上其优势，腹部超声作为儿童和青少年疑似中肠旋转不良伴或不伴扭转的一线诊断试验具有很强的说服力。
Despite the advantages of ultrasound (US), upper gastrointestinal contrast series (UGI) remains the first line diagnostic modality in the diagnosis of midgut malrotation and volvulus in children. Evaluate the diagnostic accuracy of US in the diagnosis of malrotation with or without volvulus in children and adolescents aged 0–21 years, compared to the reference standard (diagnosis by surgery, UGI, CT, MRI, and clinical follow-up individually or as a composite). We searched the electronic databases Ovid-MEDLINE, Embase, Scopus, CINAHL, and the Cochrane library in October 2019 and updated on August 18, 2020. Studies evaluating the diagnostic performance of US for diagnosis of midgut malrotation with or without volvulus in children (0–21 years). The data were extracted independently by 2 authors and a bivariate model was used for synthesis. Meta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI, 89%−97%) and summary specificity of 100% (95% CI, 97%−100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared to the reference standard. Subgroup analysis and meta-regression revealed better diagnostic accuracy in malrotation not complicated by volvulus, in the neonatal population and enteric fluid administration before US. Moderate certainty evidence suggests excellent diagnostic accuracy and coupled with the advantages, a strong case exists for the use of abdominal US as the first line diagnostic test for suspected midgut malrotation with or without volvulus in children and adolescents.
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影响因子：
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