Khorana Jiraporn, Phiromkanchanasak Phawinee, Kumsattra Jitthiwimon, Klinoun Suparada, Aksorn Suthasinee, Chantakhow Sireekarn, Tepmalai Kanokkan, Singhavejsakul Jesda
Department of Surgery, Division of Pediatric Surgery, Faculty of Medicine, Chiang Mai University Hospital, Chiangmai 50200, Thailand.
Center of Clinical Epidemiology and Clinical Statistic, Faculty of Medicine, Chiang Mai University Hospital, Chiangmai 50200, Thailand.
Healthcare (Basel). 2021 Jun 4;9(6):678. doi: 10.3390/healthcare9060678.
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.
先天性巨结肠（HSCR）的诊断依赖于病史、体格检查和各项检查。某些检查方式在基层医院无法开展。本研究旨在开发用于HSCR诊断和早期转诊的临床评分模型，尤其是在无法进行相关检查的地区。本研究纳入了2006年1月至2020年12月期间483例连续的15岁以下疑似HSCR患者，其中207例（42.86%）患者被诊断为HSCR，276例（51.14%）患者属于非HSCR组。预测模型纳入了五个临床参数。临床参数包括年龄小于1个月、男性、足月儿、胎粪排出延迟史和小肠结肠炎史，其曲线下面积（AuROC）为72%。预测评分范围为0 - 7分，0 - 3分意味着患HSCR的风险较低（低风险率阳性 = 0.37）。我们得出结论，疑似HSCR且临床评分为4 - 7分的患者患HSCR的可能性很高，因此建议这些患者尽早转诊以进行进一步检查，即结肠造影和直肠吸引活检。对于HSCR可能性较低的情况，仍需进行临床观察。这种临床评分系统可作为一种筛查工具，以防止诊断延误和并发症的发生。
