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Primary care faecal calprotectin testing in children with suspected inflammatory bowel disease: a diagnostic accuracy
Gareth J Walker1,2, Neil Chanchlani2,3, Amanda Thomas1,2
1Gastroenterology, Royal Devon and Exeter Hospital, Exeter, UK.
Insights
Fecal calprotectin testing in primary care accurately diagnoses inflammatory bowel disease (IBD) in children. This method reduces unnecessary referrals and healthcare costs for suspected IBD cases.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Accuracy Studies
- Primary Care Medicine
Background:
- Inflammatory bowel disease (IBD) diagnosis in children often involves lengthy investigations.
- General practitioners (GPs) require accurate tools to identify IBD in primary care settings.
- Faecal calprotectin is a promising biomarker for intestinal inflammation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of faecal calprotectin testing for IBD in children.
- To assess the utility of a primary care-based calprotectin referral pathway.
- To determine if calprotectin testing impacts the time to diagnosis and healthcare utilization.
Main Methods:
- A prospective observational cohort study was conducted across 48 GP practices.
- 195 children (aged 4-18) with suspected IBD underwent primary care-driven faecal calprotectin testing.
- Diagnostic accuracy was determined by comparing calprotectin results to a 12-month reference standard.
Main Results:
- Faecal calprotectin testing demonstrated a diagnostic accuracy of 91% for IBD.
- Sensitivity and specificity for distinguishing IBD were 100% and 91%, respectively.
- Negative calprotectin tests (100% NPV) led to reduced secondary care referrals and diagnostic tests.
Conclusions:
- Faecal calprotectin testing in primary care is effective in differentiating IBD from functional gut disorders in children.
- This approach reduces secondary care referrals and associated healthcare costs.
- Calprotectin testing supports efficient diagnostic pathways for pediatric IBD.
Objective:
To determine the diagnostic accuracy of calprotectin to diagnose inflammatory bowel disease (IBD) in children in whom general practitioners (GPs) suspected IBD.
Design:
Prospective observational cohort study of a new calprotectin-based primary care referral pathway.
Setting:
48 GP practices and gastroenterology secondary care services at the Royal Devon and Exeter NHS Foundation Trust in the South-West of England, UK.
Patients:
195 children aged between 4 and 18 years referred on the pathway between January 2014 and August 2017 for investigation of gastrointestinal symptoms were included.
Interventions:
Primary-care-driven faecal calprotectin testing. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard.
Main Outcome Measures:
Diagnostic accuracy of calprotectin testing to detect IBD.
Results:
7% (13/195) tested patients were diagnosed with IBD. Using our prespecified cut-off of 100 µg/g, calprotectin had a diagnostic accuracy of 91% (95% CI 86% to 95%) with a sensitivity for distinguishing IBD from non-IBD of 100% (95% CI 75% to 100%), a specificity of 91% (95% CI 85% to 94%), a positive predictive value of 43% (95% CI 25% to 63%) and a negative predictive value of 100% (95% CI 98% to 100%). Calprotectin testing had no effect on the time to diagnosis, but a negative test contributed to saved referrals and was associated with fewer diagnostic tests in secondary care.
Conclusions:
Calprotectin testing of children with suspected IBD in primary care accurately distinguishes IBD from a functional gut disorder, reduces secondary care referrals and associated diagnostic healthcare utilisation.
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