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Rectal biopsy leads to surgery in 1 out of every 4 infants: Study
In a recent development, a team of researchers have highlighted that 1 in every 4 infants undergoing rectal biopsy proceeds to surgery. These findings, from a cross-sectional, retrospective review of medical records, were published in the Journal of Pediatric Gastroenterology and Nutrition.
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
Dr Satabdi Saha (BDS, MDS) is a practicing pediatric dentist with a keen interest in new medical researches and updates. She has completed her BDS from North Bengal Dental College ,Darjeeling. Then she went on to secure an ALL INDIA NEET PG rank and completed her MDS from the first dental college in the country – Dr R. Ahmed Dental College and Hospital. She is currently attached to The Marwari Relief Society Hospital as a consultant along with private practice of 2 years. She has published scientific papers in national and international journals. Her strong passion of sharing knowledge with the medical fraternity has motivated her to be a part of Medical Dialogues.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751