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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).
Insights
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.
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.
Background:
Current adult guidelines for the management of choledocholithiasis (CDL) may not be appropriate for children. We hypothesized adult preoperative predictive factors are not reliable for predicting CDL in children.
Study Design:
A multicenter retrospective cohort study was performed evaluating children (≤18 years of age) who underwent cholecystectomy for gallstone disease at 10 children's hospitals. Univariate and multivariable analyses were used to identify factors independently associated with CDL. Patients were stratified into risk groups demonstrating the presence of predictive factors for CDL. Statistical analyses were performed, and chi-square analyses were used with a significance of p < 0.05.
Results:
A total of 979 cholecystectomy patients were analyzed. The diagnosis of CDL was confirmed in 222 patients (22.7%) by magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, or intraoperative cholangiography. Three predictive factors were identified: (1) Dilated common bile duct ≥6 mm; (2) Ultrasound with Choledocholithiasis; and (3) Total bilirubin ≥1.8 mg/dL (pediatric DUCT criteria). Risk groups were based on the number of predictive factors: very high (3), high (2), intermediate (1), and low (0). The pediatric DUCT criteria demonstrated accuracies of >76%, specificity of >78%, and negative predictive values of >79%. Adult factors (elevated aspartate aminotransferase/alanine aminotransferase, pancreatitis, BMI, and age) did not independently predict CDL. Based on risk stratification, the high- and very-high-risk groups demonstrated higher predictive capacity for CDL.
Conclusions:
Our study demonstrated that the pediatric DUCT criteria, incorporating common bile duct dilation, choledocholithiasis seen on ultrasound, and total bilirubin ≥1.8 mg/dL, highly predicts the presence of choledocholithiasis in children. Other adult preoperative factors are not predictive of common bile duct stone in children.
