Abstract：
BACKGROUND: Ultrasound (US) is gaining acceptance for the evaluation of midgut volvulus in children. However, its impact on clinical outcomes is unknown. We aim to determine whether using US as a first-line modality changes imaging mobilization, time to surgery and re-feeding, length of stay, and frequency of bowel necrosis, short bowel syndrome, and death.
METHODS: An IRB-approved retrospective cohort study was performed at a tertiary pediatric institution. Eighty children with surgically confirmed midgut volvulus from 2014 to 2021 were compared before and after implementation of US as first-line imaging and based on the modality used to diagnose midgut volvulus.
RESULTS: Outcomes were not statistically different pre- versus post-implementation. Compared with patients who had UGI only, those who had US only or both had significantly quicker imaging mobilization (median: -33 min; 95% CI: -61.2, -4.8; p = 0.023 and median: -31 min; 95% CI: -58.5, -3.6; p = 0.028 respectively). Patients with US only were less likely to have bowel necrosis compared with those who had UGI only (9.1% versus 43.8%, p = 0.042). Patients who had US only or both were less likely to develop short bowel syndrome compared to UGI only (4.8% US only, 0% both, 40% UGI only; p = 0.027 for US only, p = 0.005 for both).
CONCLUSIONS: No statistically significant change in outcomes was found after implementation of US as first-line imaging for midgut volvulus. However, patients diagnosed with US only or US in combination with UGI had quicker imaging mobilization and decreased frequency of bowel necrosis and short bowel syndrome. Findings suggest that US has potential to improve patient outcomes.
METHODS: III.
METHODS: An IRB-approved retrospective cohort study was performed at a tertiary pediatric institution. Eighty children with surgically confirmed midgut volvulus from 2014 to 2021 were compared before and after implementation of US as first-line imaging and based on the modality used to diagnose midgut volvulus.
RESULTS: Outcomes were not statistically different pre- versus post-implementation. Compared with patients who had UGI only, those who had US only or both had significantly quicker imaging mobilization (median: -33 min; 95% CI: -61.2, -4.8; p = 0.023 and median: -31 min; 95% CI: -58.5, -3.6; p = 0.028 respectively). Patients with US only were less likely to have bowel necrosis compared with those who had UGI only (9.1% versus 43.8%, p = 0.042). Patients who had US only or both were less likely to develop short bowel syndrome compared to UGI only (4.8% US only, 0% both, 40% UGI only; p = 0.027 for US only, p = 0.005 for both).
CONCLUSIONS: No statistically significant change in outcomes was found after implementation of US as first-line imaging for midgut volvulus. However, patients diagnosed with US only or US in combination with UGI had quicker imaging mobilization and decreased frequency of bowel necrosis and short bowel syndrome. Findings suggest that US has potential to improve patient outcomes.
METHODS: III.
摘要：
背景：超声（US）在儿童中肠扭转的评估中越来越被接受。然而,其对临床结局的影响尚不清楚.我们的目标是确定使用US作为一线模态是否会改变成像动员，手术和重新喂食的时间，逗留时间,肠坏死的频率，短肠综合征,和死亡。
方法：在三级儿科机构进行了IRB批准的回顾性队列研究。比较了2014年至2021年手术证实的中肠扭转的80名儿童在US实施之前和之后作为一线成像并基于用于诊断中肠扭转的方式。
结果：结果在实施前后没有统计学差异。与仅有UGI的患者相比，仅使用US或同时使用US的患者的成像动员明显更快(中位数:-33分钟;95%CI:-61.2,-4.8;p=0.023,中位数:-31分钟;95%CI:-58.5,-3.6;p=0.028).与仅使用UGI的患者相比，仅使用US的患者发生肠坏死的可能性较小（9.1％对43.8％，p=0.042)。与仅使用UGI相比，仅使用US或同时使用US的患者发生短肠综合征的可能性较小（仅使用US的4.8％，均为0%,仅40%UGI；仅美国，p=0.027，两者的p=0.005)。
结论：在实施US作为中肠扭转的一线成像后，未发现结果有统计学意义的变化。然而,诊断为单纯US或US联合UGI的患者影像学动员更快,肠坏死和短肠综合征的发生频率降低.研究结果表明，美国有可能改善患者的预后。
方法：III.
方法：在三级儿科机构进行了IRB批准的回顾性队列研究。比较了2014年至2021年手术证实的中肠扭转的80名儿童在US实施之前和之后作为一线成像并基于用于诊断中肠扭转的方式。
结果：结果在实施前后没有统计学差异。与仅有UGI的患者相比，仅使用US或同时使用US的患者的成像动员明显更快(中位数:-33分钟;95%CI:-61.2,-4.8;p=0.023,中位数:-31分钟;95%CI:-58.5,-3.6;p=0.028).与仅使用UGI的患者相比，仅使用US的患者发生肠坏死的可能性较小（9.1％对43.8％，p=0.042)。与仅使用UGI相比，仅使用US或同时使用US的患者发生短肠综合征的可能性较小（仅使用US的4.8％，均为0%,仅40%UGI；仅美国，p=0.027，两者的p=0.005)。
结论：在实施US作为中肠扭转的一线成像后，未发现结果有统计学意义的变化。然而,诊断为单纯US或US联合UGI的患者影像学动员更快,肠坏死和短肠综合征的发生频率降低.研究结果表明，美国有可能改善患者的预后。
方法：III.
