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Repeatability and Reliability of Home-Based Stool Color Card Screening for Biliary Atresia Based on Results in China
Yan-Hong Gu1, Jin-Qi Zhao2, Yuan-Yuan Kong2
1Department of Hygiene and Public Health, Osaka Medical College.
Insights
The digital stool color card (SCC) effectively screens for biliary atresia (BA) in infants. This study confirms its high reliability and repeatability in both China and Japan, aiding early diagnosis and treatment.
Area of Science:
- Pediatrics
- Hepatology
- Public Health Screening
Background:
- Biliary atresia (BA) is a leading cause of childhood liver disease and mortality.
- Early diagnosis and surgical intervention (Kasai portoenterostomy) are critical for improving patient outcomes.
- The stool color card (SCC) is a screening tool used to detect potential BA cases.
Purpose of the Study:
- To evaluate the repeatability and reliability of a digital edition of the stool color card (SCC) for biliary atresia (BA) screening.
- To compare the performance of the digital SCC in Beijing, China, and Sapporo, Japan.
Main Methods:
- The digital SCC was distributed to guardians of infants in Beijing (n=27,561) and Sapporo (n=37,478).
- Data were collected through various methods including health checkups and mobile services over several years.
- Infants were screened at multiple checkpoints after birth using the SCC.
Main Results:
- Two BA patients were identified in Beijing and two in Sapporo.
- The digital SCC demonstrated high sensitivity and specificity in both locations.
- The frequency distribution of reported stool colors was similar across both cities.
Conclusions:
- The current digital edition of the stool color card (SCC) exhibits excellent repeatability and reliability for infant biliary atresia (BA) screening.
- This tool shows promise for widespread implementation in neonatal screening programs globally.
Abstract:
Biliary atresia (BA) is the most frequent hepatic cause of death in early childhood. Early referral and timely Kasai portoenterostomy are essential for the improvement of long-term native liver survival rate of BA patients. Screening with stool color card (SCC) has been implemented in Japan since 1994. Recently current digital edition of SCC consisted of seven digitally created images was introduced to China. Our study aimed to evaluate the repeatability and reliability of same edition of SCC used in Beijing, China and Sapporo, Japan. In Beijing from 2013 to 2014, SCCs were distributed to infants' guardians by trained nurses in maternal facilities during information sessions on neonatal screening programs. SCC was used at three checkpoints for each infant after birth for screening. The SCC data were collected from 27,561 infants (92.5%) in Beijing by 42-day health checkup, mobile phone and social network services. In Sapporo from 2012 to 2015, the SCCs with a postcard and guardian instructions were inserted into Maternal and Child Health Handbook and distributed to all pregnant women. The data were collected from a total of 37,478 (94.3%) infants in Sapporo via the postcard during the 1st month infant health checkup. We thus identified two BA patients in Sapporo and two BA patients in Beijing. High rates of sensitivity and specificity in both cities were observed. The frequency distribution of color images on SCC reported in both cities was similar. This study shows excellent repeatability and reliability of the current digital edition of SCC.
