Couselo Miguel, Ibáñez Vicente, Pemartín Beatriz, Fonseca Rosa, Vila Juan José
Pediatric Surgery Department, Hospital Universitari i Politècnic La Fe, Av/Fernando Abril Martorell 106, 46026, Valencia, Spain.
Pediatric Surgery Department, Hospital General Universitari de Castelló, Castelló de la Plana, Spain.
Pediatr Surg Int. 2024 Dec 28;41(1):50. doi: 10.1007/s00383-024-05944-1.
To assess the diagnostic performance of hemoglobin concentration for Meckel's diverticulum (MD) and evaluate if hemoglobin levels could be useful in the surgical decision-making process of children with lower gastrointestinal bleeding (LGIB).
Retrospective cohort study of children with LGIB attending the emergency department between 2011 and 2021. Episodes of LGIB were divided into two groups: MeckD (MD diagnosed by surgery) and non-MeckD. Demographic and clinical variables were recorded. Comparisons between groups were made using the χ2 and the Mann-Whitney U tests. The diagnostic performance of hemoglobin for MD was studied using ROC curves.
Eight hundred and nineteen episodes of LGIB were considered. Blood samples were obtained in 233 cases (31 with MD). There were differences between MeckD and non-MeckD in hemoglobin concentration (8.7 vs. 12.6; U = 592; p < 0.01), hematochezia (83.9% vs. 50.5%; χ2 = 12.1; p < 0.01), absence of other symptoms (61.3% vs. 39.6%; χ2 = 5.2; p < 0.02) and blood transfusions (41.9% vs. 9.9%; χ2 = 74.8; p < 0.01). Hemoglobin levels ≤ 8.3 g/dL obtained a specificity ≥ 99.01% and a positive likelihood ratio ≥ 35.8 for MD. The area under the curve was 0.91 (95% CI 0.86-0.94).
Hemoglobin showed a good diagnostic performance for MD. Low hemoglobin levels could guide surgical indications in the management of children with LGIB.
评估血红蛋白浓度对梅克尔憩室（MD）的诊断效能，并评估血红蛋白水平在小儿下消化道出血（LGIB）手术决策过程中是否有用。
对2011年至2021年期间在急诊科就诊的LGIB患儿进行回顾性队列研究。LGIB发作分为两组：MeckD（手术诊断为MD）和非MeckD。记录人口统计学和临床变量。使用χ2检验和曼-惠特尼U检验进行组间比较。使用ROC曲线研究血红蛋白对MD的诊断效能。
共考虑了819例LGIB发作。233例（31例为MD）采集了血样。MeckD组和非MeckD组在血红蛋白浓度（8.7对12.6；U = 592；p < 0.01）、便血（83.9%对50.5%；χ2 = 12.1；p < 0.01）、无其他症状（61.3%对39.6%；χ2 = 5.2；p < 0.02）和输血（41.9%对9.9%；χ2 = 74.8；p < 0.01）方面存在差异。血红蛋白水平≤8.3 g/dL对MD的特异性≥99.01%，阳性似然比≥35.8。曲线下面积为0.91（95%CI 0.86 - 0.94）。
血红蛋白对MD显示出良好的诊断效能。低血红蛋白水平可为LGIB患儿的手术指征提供指导。
