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Methods of Gastric Tube Placement Verification in Neonates, Infants, and Children

A Systematic Review and Meta-Analysis

Lin, Tian MM1; Shen, Yan MSN1; Gifford, Wendy PhD2; Qin, Xiu-Qun MM3; Liu, Xue-Lian MM3; Lan, Yu-Tao MD1; Chen, Ken MM1; Harrison, Denise PhD4

The American Journal of Gastroenterology: August 20, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.14309/ajg.0000000000000358

OBJECTIVES: To evaluate diagnostic performance of multiple methods used to assess gastric tube placement verification in neonates, infants, and children.

METHODS: A systematic review using the methods outlined in the Cochrane Handbook for Reviews of Diagnostic Test Accuracy was conducted. Eight databases were searched. Studies on neonates, infants, and children in which researchers compared different methods for gastric tube placement verification with x-ray reference standard were eligible in the review.

RESULTS: Eight studies involving 911 participants that evaluated 9 index tests for gastric tube placement verification were included. Most studies were of moderate methodological quality, and most index tests were assessed in small individual studies. pH testing with cutoff values ≤ 6 for gastric tube position confirmation was the only index test subjected to meta-analysis, with the summary sensitivity and specificity being 0.77 (95% confidence interval [CI] 0.56–0.90) and 0.42 (95% CI 0.16–0.73). Other tests for gastric tube placement verification showed great variations in sensitivities and specificities.

DISCUSSION: pH ≤ 6 is not sufficiently accurate to be recommended for gastric tube placement verification in neonates, infants, and children. Diagnostic performance of pH ≤ 4 or 5 and other methods cannot be determined because of the paucity of data and methodological variations in studies. Clinical practice related to the diagnostic tests used will continue to be dictated by local preferences and cost factors, until stronger evidence becomes available.

1School of Nursing, Guangdong Pharmaceutical University, Guangzhou, China;

2School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada;

3Pediatric Medical Center, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China;

4School of Nursing, Faculty of Health Sciences, University of Ottawa and Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.

Correspondence: Yu-Tao Lan, MD. E-mail: and Ken Chen, MM. E-mail:

SUPPLEMENTARY MATERIAL accompanies this paper at,, and

Received January 24, 2019

Accepted June 17, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.