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

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.