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Pediatric DUCT Score: A Highly Specific Predictive Model for Choledocholithiasis in Children.

Romeo C Ignacio¹, Lorraine I Kelley-Quon², Shadassa Ourshalimian²

¹From the Division of Pediatric Surgery, Department of Surgery, University of California San Diego, Rady Children's Hospital San Diego, San Diego, CA (Ignacio).

Journal of the American College of Surgeons

|February 14, 2023

Summary

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New pediatric DUCT criteria accurately predict choledocholithiasis (CDL) in children. Adult factors for predicting CDL in children were unreliable, highlighting the need for pediatric-specific guidelines.

Area of Science:

Pediatric Surgery
Gastroenterology
Hepatology

Background:

Current adult guidelines for managing choledocholithiasis (CDL) may not be suitable for pediatric patients.
Adult preoperative factors for predicting CDL have shown limited reliability in children.

Purpose of the Study:

To evaluate the effectiveness of adult predictive factors for CDL in children.
To develop and validate a pediatric-specific predictive model for CDL.

Main Methods:

A multicenter retrospective cohort study included 979 pediatric patients (≤18 years) undergoing cholecystectomy.
Univariate and multivariable analyses identified factors associated with CDL, leading to the development of the pediatric DUCT criteria.
Patients were stratified into risk groups based on the presence of predictive factors.

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Main Results:

The pediatric DUCT criteria (common bile duct dilation ≥6 mm, ultrasound-confirmed CDL, total bilirubin ≥1.8 mg/dL) demonstrated high accuracy (>76%), specificity (>78%), and negative predictive value (>79%).
Adult factors such as elevated liver enzymes, pancreatitis, BMI, and age did not independently predict CDL in children.
Risk stratification using the pediatric DUCT criteria showed higher predictive capacity for CDL in high- and very-high-risk groups.

Conclusions:

The pediatric DUCT criteria effectively predict choledocholithiasis in children.
Pediatric-specific factors are crucial for accurate CDL prediction, and adult criteria are not applicable.