Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Pediatrics, Isala Hospital, Zwolle, The Netherlands.
PLoS One. 2017 Dec 6;12(12):e0189111. doi: 10.1371/journal.pone.0189111. eCollection 2017.
In children with symptoms suggestive of inflammatory bowel disease (IBD) who present in primary care, the optimal test strategy for identifying those who require specialist care is unclear. We evaluated the following three test strategies to determine which was optimal for referring children with suspected IBD to specialist care: 1) alarm symptoms alone, 2) alarm symptoms plus c-reactive protein, and 3) alarm symptoms plus fecal calprotectin.
A prospective cohort study was conducted, including children with chronic gastrointestinal symptoms referred to pediatric gastroenterology. Outcome was defined as IBD confirmed by endoscopy, or IBD ruled out by either endoscopy or unremarkable clinical 12 month follow-up with no indication for endoscopy. Test strategy probabilities were generated by logistic regression analyses and compared by area under the receiver operating characteristic curves (AUC) and decision curves.
We included 90 children, of whom 17 (19%) had IBD (n = 65 from primary care physicians, n = 25 from general pediatricians). Adding fecal calprotectin to alarm symptoms increased the AUC significantly from 0.80 (0.67-0.92) to 0.97 (0.93-1.00), but adding c-reactive protein to alarm symptoms did not increase the AUC significantly (p > 0.05). Decision curves confirmed these patterns, showing that alarm symptoms combined with fecal calprotectin produced the diagnostic test strategy with the highest net benefit at reasonable threshold probabilities.
In primary care, when children are identified as being at high risk for IBD, adding fecal calprotectin testing to alarm symptoms was the optimal strategy for improving risk stratification.
在以炎症性肠病（IBD）症状就诊于初级保健机构的儿童中，确定需要专科治疗的患者的最佳检测策略尚不清楚。我们评估了以下三种检测策略，以确定将疑似 IBD 患儿转诊至专科治疗的最佳策略：1）仅出现警报症状，2）出现警报症状加 C 反应蛋白，3）出现警报症状加粪便钙卫蛋白。
进行了一项前瞻性队列研究，纳入了因慢性胃肠道症状而转至儿科胃肠病学的儿童。结局定义为通过内镜检查确诊的 IBD，或通过内镜检查或 12 个月无明显临床随访排除 IBD（无内镜检查指征）。通过逻辑回归分析生成检测策略的概率，并通过接受者操作特征曲线（AUC）和决策曲线进行比较。
我们纳入了 90 名儿童，其中 17 名（19%）患有 IBD（来自初级保健医生的 65 名，来自普通儿科医生的 25 名）。将粪便钙卫蛋白添加到警报症状中可使 AUC 显著增加，从 0.80（0.67-0.92）增加到 0.97（0.93-1.00），但将 C 反应蛋白添加到警报症状中并未显著增加 AUC（p>0.05）。决策曲线证实了这些模式，表明警报症状与粪便钙卫蛋白联合使用可在合理的阈值概率下产生具有最高净获益的诊断检测策略。
在初级保健中，当儿童被确定为患有 IBD 的高风险时，将粪便钙卫蛋白检测添加到警报症状中是改善风险分层的最佳策略。
