Rectal biopsy leads to surgery in 1 out of every 4 infants: Study

There is an abundance of literature supporting the diagnostic capabilities of rectal biopsy, particularly suction rectal biopsy, with a 95% to 97% sensitivity and 99% specificity . Although the test's accuracy is well established, there is little data outside of single institution studies that lend insight into how frequently providers choose the correct patient. Although rectal biopsy has long been established as the criterion standard for the diagnosis of Hirschsprung disease, little to no information exists regarding nationwide rates of rectal biopsy positivity or interinstitutional variability.

So,researchers sought to determine the national rate of rectal biopsy positivity and factors contributing to institutional variability.

The study design consisted of a retrospective review of the Children's Hospital Association's (CHA) Pediatric Health Information System from 2009 to 2018 identified infants <100 days old with ICD-9/ICD-10 procedural codes for rectal biopsy in addition to codes for pull-through procedures within 500 days of life as a proxy for positive biopsy. A subgroup analysis of only patients biopsied at institutions with positive biopsy rates 1 standard deviation above or below the mean positive biopsy rate (deemed high and low outliers) was performed to better delineate these populations.

Results brought forth some interesting facts.

• A total of 7225 children underwent rectal biopsies between 2009 and 2018 at 52 Children's Hospital Association Hospitals.
• Mean positive biopsy rate for individual institutions was 21.5% (standard deviation ± 6.4%).
• Linear regression to predict the effect of hospital surgical volume on positive biopsy rate demonstrated no volume outcome relationship (R2 = 0.049).
• Patients at high outlier hospitals for biopsy positivity were found to travel significantly further to the hospital (232.5 vs 123.1 miles, P < 0.0001) when compared to patients presenting at low outlier hospitals.

"There appears to be little interinstitutional variability in the rate of surgery following rectal biopsy for presumed Hirschsprung and no significant relationship to surgical volume. Establishing a national standard to which institutions can compare their own clinical acumen is important from a quality and safety perspective. In the absence of a costly multi-institutional prospective study, these data can be used as a measuring stick for where a hospital may fall on the bell curve of biopsy positivity at related institutions."the team concluded.

For full article follow the link: 10.1097/MPG.0000000000002960

Primary soure: Journal of Pediatric Gastroenterology and Nutrition