A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia
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In brief
In brief
This prospective study validates a modified Simple BA Scoring System for diagnosing biliary atresia in infants with cholestatic jaundice, achieving 96% sensitivity and 86% accuracy at a cut-off score of 3. The bedside scoring tool combines ultrasound findings, biochemical markers, and clinical parameters to reduce unnecessary surgical explorations in neonates.
- Modified SBASS (score 0-6) uses 4 parameters: GB length <1.6cm, triangular cord sign, conjugated/total bilirubin >0.7, and GGT ≥200 U/L
- At cutoff ≥3, modified SBASS achieved 96.2% sensitivity and 86.3% accuracy for diagnosing biliary atresia in 73 cholestatic infants
- GGT ≥200 U/L showed highest sensitivity (94.2%) while triangular cord sign had highest specificity (95.2%) for BA diagnosis
- SBASS provides bedside, non-invasive tool to exclude BA and reduce unnecessary surgical explorations in infantile cholestasis
Written by the GCMD Library team from the article.
Abstract
Purpose
Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA.
Methods
We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021–December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0–6), consists of gall bladder length < 1.6 cm (+ 1), presence of triangular cord sign (+ 1), conjugated bilirubin:total bilirubin ratio > 0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2).
Results
73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%.
Conclusion
The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.