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Development of Clinical Referral Score Model for Early Diagnosis of Hirschsprung's Disease in Suspected Pediatric
Jiraporn Khorana1,2, Phawinee Phiromkanchanasak3, Jitthiwimon Kumsattra3
1Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chiangmai 50200, Thailand.
Insights
This study developed a clinical scoring system to aid in diagnosing Hirschsprung
Area of Science:
- Pediatric Surgery
- Clinical Diagnostics
- Gastroenterology
Background:
- Hirschsprung's disease (HSCR) diagnosis typically requires specialized investigations.
- Access to advanced diagnostic modalities is limited in primary healthcare settings.
- Delayed diagnosis of HSCR can lead to severe complications.
Purpose of the Study:
- To develop a clinical score model for early diagnosis and referral of HSCR.
- To create a screening tool for resource-limited areas.
- To improve diagnostic accuracy in suspected pediatric HSCR cases.
Main Methods:
- Retrospective analysis of 483 pediatric patients under 15 years old with suspected HSCR.
- Inclusion of five key clinical parameters: age < 1 month, male gender, term infant, delayed meconium passage, and enterocolitis history.
- Development and validation of a prediction score based on these parameters.
Main Results:
- The clinical prediction model achieved an Area Under the Receiver Operating Characteristic curve (AuROC) of 72%.
- A score of 4-7 indicated a high probability of HSCR, prompting early referral.
- A score of 0-3 suggested a low risk, warranting clinical observation.
Conclusions:
- The developed clinical scoring system is effective for screening suspected HSCR cases.
- Early referral for high-risk patients (score 4-7) is recommended for definitive investigations.
- This tool can prevent diagnostic delays and associated complications in primary care settings.
Abstract:
The diagnosis of Hirschsprung's disease (HSCR) relies on history, physical examination, and investigations. Some of investigation modalities could not be done in primary hospital. This study was aimed to develop the clinical score model for diagnosing and early referrals of HSCR, especially in areas where investigations were not available. Overall 483 consecutive suspected HSCR patients who were under 15 years old from January 2006 to December 2020 were included in this study, with 207 (42.86%) patients diagnosed with HSCR and 276 (51.14%) patients in the non-HSCR group. Five clinical parameters were included in the prediction model. The AuROC of clinical parameters, which included having an age younger than one month, male gender, the term infant, history of delayed meconium passage, and history of enterocolitis, was 72%. The prediction score ranged from 0-7, with a score 0-3 meaning a low risk to be HSCR (LHR+ = 0.37). We concluded that patients with suspected HSCR who had clinical score 4-7 had a high probability to be HSCR and, thus, it was suggested that these patients have an early referral for further investigations, which were contrast enema and rectal suction biopsy. In the case of a low probability of HSCR, clinical observation is still warranted. This clinical scoring system can be used as a screening tool to prevent delay diagnosis and complications.
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