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Clinical Hub,References,Emergency Department Resources,Emergency Department Pediatric Resources

Vomiting Infant US Guidelines

Vomiting Infant US Guidelines - Clinical Hub, References, Emergency Department Resources, Emergency Department Pediatric Resources


WHY: to improve quality of care provided to patients by: 

WHO: infants 1 year old or less, presenting to the emergency department with NON-BILIOUS emesis who require further diagnostic imaging.

Vomiting Infant US Guidelines

HOW: by ordering the "Ultrasound-Vomiting Infant" protocol which is now available in Epic for Emergency Department Physicians.

BACKGROUND: The advantages of ultrasound in the pediatric population are well known: 1-3 

In addition, ultrasound has been well demonstrated to be a highly effective test for each of the diagnoses this protocol examines (PPV-positive predictive value, NPV-negative predictive value):

Pyloric Stenosis1, 4-8 90-100% 91-100% 94-100% 95% 
Intussusception1,4, 9-13 97.5-100% 88-100% 87-99%  90-100%
Malrotation and Volvulus14-15 70-86.5% 74-96% 62% 96-97% 
UPJ Obstruction16-17 98% 74-78%  70% 98% 


1.) Vasavada, Pauravi. "Ultrasound Evaluation of Acute Abdominal Emergencies in Infants and Children." Radiologic Clinics of North America 42.2 (2004): 445-56. Pubmed. Web. 27 July 2014.

2.) Leeson, Kimberly, and Ben Leeson. "Pediatric Ultrasound Applications in the Emergency Department." Emerg Med Clin N Am 31 (2013): 809-29.

3.) Swischuk, Leonard E. "Emergency Pediatric Imaging: Current Status and Update." Seminars in Ultrasound, CT, and MRI 28.2 (2007): 158-68. Pubmed. Web. 26 July 2014

4.) Gallagher, Rachel, and Jason Levy. "Advances in Point-of-care Ultrasound in Pediatric Emergency Medicine." Curr Opin Pediatr 26 (2014): 265-71. Pubmed. Web. 26 July 2014

5.) Schouw, Y. T Van Der, M. T Van Der Velden, C. Hitge-Boetes, A. L. Verbeek, and S. H. Ruijs. "Diagnosis of Hypertrophic Pyloric Stenosis: Value of Sonography When Used in Conjunction with Clinical Findings and Laboratory Data." American Journal of Roentgenology 163.4 (1994): 905-09. Pubmed. Web. 26 July 2014

6.) Sivitz, Adam B., Cena Tejani, and Stephanie G. Cohen. "Evaluation of Hypertrophic Pyloric Stenosis by Pediatric Emergency Physician Sonography." Ed. Marc H. Gorelick. Academic Emergency Medicine 20.7 (2013): 646-51. Pubmed. Web. 26 July 2014.

7.) Neilson, D., and A.s. Hollman. "The Ultrasonic Diagnosis of Infantile Hypertrophic Pyloric Stenosis: Technique and Accuracy." Clinical Radiology 49.4 (1994): 246-47. Pubmed. Web. 26 July 2014.

8.) Hermanz-Schulman, M., and LL Sells, et al "Hypertrophic Pyloric Stenosis in the Infant without a Palpable Olive: Accuracy of Sonographic Diagnosis." Radiology 193.3 (1994): 771-76. Pubmed. Web. 26 July 2014

9.) Bhisitkul, Donna M., Robert Listernick, Arnold Shkolnik, James S. Donaldson, Bret D. Henricks, Kate A. Feinstein, and Sandra K. Fernbach. "Clinical Application of Ultrasonography in the Diagnosis of Intussusception." The Journal of Pediatrics 121.2 (1992): 182-86. Pubmed. Web. 26 July 2014.

10.) Henderson, Alicia Anne, Sudha A. Anupindi, Sabah Servaes, Richard I. Markowitz, Paul L. Aronson, Robert J. Mcloughlin, and Rakesh D. Mistry. "Comparison of 2-View Abdominal Radiographs With Ultrasound in Children With Suspected Intussusception." Pediatric Emergency Care 29.2 (2013): 145-50. Pubmed. Web. 26 July 2014.

11.) Daneman, Alan, and Oscar Navarro. "Intussusception Part 1: A Review of Diagnostic Approaches." Pediatric Radiology 33 (2003): 79-85. Pubmed. Web. 26 July 2014

12.) Justice, Frances A., Margaret Campo, Nguyen Thanh Liem, Tran Ngoc Son, Tran Phan Ninh, and Julie E. Bines. "Accuracy of Ultrasonography for the Diagnosis of Intussusception in Infants in Vietnam." Pediatric Radiology 37.2 (2007): 195-99. Pubmed. Web. 26 July 2014.

13.) Verschelden, P., and D. Filiatrault. "Intussusception in Children: Reliability of US in Diagnosis--a Prospective Study." Radiology 184.3 (1994): 741-44. Pubmed. Web. 26 July 2014

14.) Orzech, Neil, Oscar M. Navarro, and Jacob C. Langer. "Is Ultrasonography a Good Screening Test for Intestinal Malrotation?" Journal of Pediatric Surgery 41.5 (2006): 1005-009. Pubmed. Web. 26 July 2014.

15.) Weinberger, E., and W. Winters. "Sonographic Diagnosis of Intestinal Malrotation in Infants:Importance of the Relative Positions of the Superior Mesenteric Vein and Artery." AJR 159 (1992): 825-28. Pubmed. Web. 26 July 2014

16.) Koelliker, SL, and JJ Cronan. "Acute Urinary Tract Obstruction. Imaging Update." Urol Clin North Amer 24.3 (1997): 571-82. Pubmed. Web. 26 July 2014

17.) Ellenbogen, Ph, Fw Scheible, Lb Talner, and Gr Leopold. "Sensitivity of Gray Scale Ultrasound in Detecting Urinary Tract Obstruction." American Journal of Roentgenology 130.4 (1978): 731-33. Pubmed. Web. 26 July 2014