Clinical Diagnostic Predictive Score for Meckel Diverticulum
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Read the article on jpedsurg.org ↗Article · Dec 2020 · 1 min read
In brief
In brief
Retrospective study of 215 pediatric patients with hematochezia developed a clinical risk score to predict Meckel diverticulum without relying on scintigraphy. Six predictive variables (infant/toddler age, symptom duration <6 days, large blood volume, hemoglobin <7 g/dL, transfusion requirement) generate a score where ≥6 points suggests proceeding directly to surgery, potentially reducing diagnostic delays.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose: Meckel diverticulum (MD) is present in 2% of the population. Many practitioner feel the diagnosis relies upon technetium-99 m pertechnetate scintigraphy. When negative, patients undergo additional invasive procedures delaying definitive therapy. This study aims to identify features of bleeding MD and generate a risk score, which could preclude unnecessary testing and facilitate earlier operation.
Methods: All patients <18-years-old who presented with hematochezia from 2005 to 2015 were identified. MD diagnosis was based on histopathology of operative tissue. Controls were patients with hematochezia undergoing colonoscopy. A points system was used generate a risk score.
Results: A total of 215 patients presented with hematochezia out of which 42 patients with MD were identified. Predictive variables included infant (OR 7, 95%CI 2–29) and toddler (OR 20, 95%CI 8–50) age groups, duration <6 days (OR 18, 95%CI 8–43), presence of large blood volume (OR 16, 95% CI 7–36), hemoglobin <7 g/dL (OR 6, 95% CI 3–15) and transfusion requirement (OR 16, 95% CI 7–38). A score of 6 or higher is highly suggestive of MD.
Conclusions: This scoring system identifies children with bleeding MD who may benefit from exploratory surgery without undergoing endoscopy. This novel scoring system can be applied to provide accurate clinical diagnosis, reduce unnecessary tests and allow prompt surgical management.