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Ultrasound for the diagnosis of malrotation and volvulus in children and adolescents: a systematic review and meta-analysis
  1. HaiThuy N Nguyen1,
  2. Madhulika Kulkarni2,
  3. Jisha Jose2,
  4. Amy Sisson3,
  5. Mary L Brandt4,
  6. Marla B K Sammer1,
  7. Mohan Pammi2
  1. 1 Radiology, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  3. 3 TMC Library, Texas Medical Center, Houston, Texas, USA
  4. 4 Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
  1. Correspondence to Prof Mohan Pammi, Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA; mohanv{at}bcm.edu

Abstract

Context 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.

Objective Evaluate the diagnostic accuracy of US in the diagnosis of malrotation with or without volvulus in children and adolescents aged 0–21 years, compared with the reference standard (diagnosis by surgery, UGI, CT, MRI, and clinical follow-up individually or as a composite).

Data sources We searched the electronic databases Ovid-MEDLINE, Embase, Scopus, CINAHL, and the Cochrane library in October 2019 and updated on 18 August 2020.

Study selection Studies evaluating the diagnostic performance of US for diagnosis of midgut malrotation with or without volvulus in children (0–21 years).

Data extraction and synthesis The data were extracted independently by two authors and a bivariate model was used for synthesis.

Results Meta-analysis of 17 cohort or cross-sectional studies and 2257 participants estimated a summary sensitivity of 94% (95% CI 89% to 97%) and summary specificity of 100% (95% CI 97% to 100%) (moderate certainty evidence) for the use of US for the diagnosis of malrotation with or without midgut volvulus compared with 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.

Conclusions 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.

  • gastroenterology
  • neonatology

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. All data included in the article.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. All data included in the article.

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Footnotes

  • Twitter @HaiThuyNguyenMD, @MarlaSammer, @mohan_pammi

  • Contributors HN conceptualised the study, collected data, assessed methodological quality of included studies, drafted the initial manuscript, and reviewed and revised the manuscript. MBKS, JJ and MK designed the data collection instruments, collected data, and reviewed and revised the manuscript. AS drafted the search strategy and performed literature search. MLB provided intellectual input and reviewed and revised the manuscript. MP conceptualised and designed the study, coordinated and supervised data collection, performed statistical analyses and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding This study was funded by the Center for Scientific Review (R03HD098482, R21HD091718).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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