Diagnostic value of hemoglobin concentration in identifying Meckel’s diverticulum in pediatric lower gastrointestinal bleeding
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In brief
In brief
This retrospective study demonstrates that hemoglobin concentration is a highly specific diagnostic marker for Meckel's diverticulum in children presenting with lower GI bleeding. Hemoglobin levels ≤8.3 g/dL showed 99% specificity, suggesting this simple lab value could guide surgical decision-making in pediatric emergency settings.
- Hemoglobin ≤8.3 g/dL has 99% specificity for Meckel's diverticulum in pediatric lower GI bleeding, with positive likelihood ratio >35.
- Children with Meckel's diverticulum present with lower hemoglobin (8.7 vs 12.6 g/dL) and more hematochezia (84% vs 51%) than other LGIB causes.
- Hemoglobin concentration (AUC 0.91) can guide surgical decision-making in pediatric lower GI bleeding when Meckel's is suspected.
- Meckel's patients require blood transfusion more frequently (42% vs 10%) compared to other causes of pediatric lower GI bleeding.
Written by the GCMD Library team from the article.
Abstract
Purpose
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).
Methods
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.
Results
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).
Conclusion
Hemoglobin showed a good diagnostic performance for MD. Low hemoglobin levels could guide surgical indications in the management of children with LGIB.