PMID- 25746690
OWN - NLM
STAT- MEDLINE
DCOM- 20151201
LR  - 20220409
IS  - 1531-5037 (Electronic)
IS  - 0022-3468 (Linking)
VI  - 50
IP  - 3
DP  - 2015 Mar
TI  - A screening algorithm for the efficient exclusion of biliary atresia in infants 
      with cholestatic jaundice.
PG  - 363-70
LID - S0022-3468(14)00513-2 [pii]
LID - 10.1016/j.jpedsurg.2014.08.014 [doi]
AB  - BACKGROUND: Neonates with cholestasis may undergo many tests before biliary 
      atresia (BA) or an alternative diagnosis is reached, and delayed intervention may 
      worsen outcomes. An optimal diagnostic approach to reduce risk, cost, and delay 
      has yet to be defined. The purpose of this study was to develop an algorithm that 
      rapidly and accurately excludes BA for infants with cholestatic jaundice. 
      METHODS: A single-center retrospective comparison of diagnostic workup was made 
      between cholestatic infants with BA, and those without BA who underwent 
      hepatobiliary iminodiacetic acid (HIDA) scan during admission. Patients were born 
      between 2000 and 2010 and those older than 100days at assessment were excluded. 
      Sensitivity and specificity analysis of predictive variables was performed and an 
      algorithm constructed. RESULTS: There were 45 BA and 167 non-BA patients. Some 
      variables were 100% sensitive for the exclusion of BA: conjugated bilirubin 
      <2.5mg/dL, gamma-glutamyl transpeptidase <150U/L, excretion on HIDA, or a normal 
      percutaneous cholangiogram. Clinical variables and ultrasound were less useful as 
      screening tests owing to low specificity and sensitivity, respectively. Liver 
      biopsy was 98% sensitive and 84% specific in the diagnosis of BA. An algorithm 
      was constructed that rules out BA with a negative laparotomy rate of 3-22%. 
      CONCLUSION: We propose a screening algorithm for infants with conjugated 
      hyperbilirubinemia that permits efficient exclusion of BA with minimal invasive 
      testing and with a low risk of negative laparotomy. This algorithm now requires 
      prospective evaluation to determine its diagnostic accuracy and its ability to 
      reduce hospital costs, patient morbidity, and time to Kasai portoenterostomy in 
      patients with BA.
CI  - Copyright (c) 2015 Elsevier Inc. All rights reserved.
FAU - Jancelewicz, Tim
AU  - Jancelewicz T
AD  - Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, 
      Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada. 
      Electronic address: tjancele@uthsc.edu.
FAU - Barmherzig, Rebecca
AU  - Barmherzig R
AD  - Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, 
      Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
FAU - Chung, Catherine T-S
AU  - Chung CT
AD  - Division of Pathology and Pediatric Laboratory Medicine, The Hospital for Sick 
      Children, Toronto, Ontario, Canada; Department of Pediatrics, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Ling, Simon C
AU  - Ling SC
AD  - Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick 
      Children, Toronto, Ontario, Canada; Department of Pediatrics, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Kamath, Binita M
AU  - Kamath BM
AD  - Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick 
      Children, Toronto, Ontario, Canada; Department of Pediatrics, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Ng, Vicky L
AU  - Ng VL
AD  - Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick 
      Children, Toronto, Ontario, Canada; Department of Pediatrics, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Amaral, Joao
AU  - Amaral J
AD  - Department of Diagnostic Imaging, Division of Image Guided Therapy, The Hospital 
      for Sick Children, Toronto, Ontario, Canada.
FAU - O'Connor, Constance
AU  - O'Connor C
AD  - Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick 
      Children, Toronto, Ontario, Canada; Department of Pediatrics, University of 
      Toronto, Toronto, Ontario, Canada.
FAU - Fecteau, Annie
AU  - Fecteau A
AD  - Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, 
      Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
FAU - Langer, Jacob C
AU  - Langer JC
AD  - Division of Pediatric Surgery, The Hospital for Sick Children, Toronto, Ontario, 
      Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Surg
JT  - Journal of pediatric surgery
JID - 0052631
SB  - IM
MH  - *Algorithms
MH  - Biliary Atresia/complications/*diagnosis
MH  - *Biopsy
MH  - Cholangiography/*methods
MH  - Diagnosis, Differential
MH  - Female
MH  - Humans
MH  - Infant, Newborn
MH  - Jaundice, Obstructive/*diagnosis/etiology
MH  - *Laparotomy
MH  - Male
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Biliary atresia
OT  - Cholestasis
OT  - Cholestatic jaundice
OT  - Neonatal
EDAT- 2015/03/10 06:00
MHDA- 2015/12/15 06:00
CRDT- 2015/03/10 06:00
PHST- 2014/03/05 00:00 [received]
PHST- 2014/07/31 00:00 [revised]
PHST- 2014/08/16 00:00 [accepted]
PHST- 2015/03/10 06:00 [entrez]
PHST- 2015/03/10 06:00 [pubmed]
PHST- 2015/12/15 06:00 [medline]
AID - S0022-3468(14)00513-2 [pii]
AID - 10.1016/j.jpedsurg.2014.08.014 [doi]
PST - ppublish
SO  - J Pediatr Surg. 2015 Mar;50(3):363-70. doi: 10.1016/j.jpedsurg.2014.08.014.