The following is a summary of “Assessing Disease Activity in Pediatric Crohn’s Disease Using Ultrasound: The Pediatric Crohn Disease Intestinal Ultrasound Score,” published in the May 2023 issue of Pediatrics by Wassenaer, et al.
For a study, researchers sought to develop an easy-to-use intestinal ultrasound (IUS) score for assessing disease activity in pediatric Crohn’s disease (CD).
Children with CD who underwent ileo-colonoscopy for disease assessment also underwent IUS the day before the procedure. The IUS findings were compared to the simple endoscopic score for CD (SES-CD) on a segmental level. In addition, multiple regression analyses were performed separately for the terminal ileum (TI) and colon to identify predictors of disease activity and develop a predictive model.
A total of 74 pediatric CD patients (median age: 15 years, 48% female) were included, with 67 TI and 364 colon segments assessed. Based on receiver operating characteristics curves, bowel wall thickness (BWT) was categorized into low [1 point: 2–3 mm (TI) and 1.6–2 mm (colon)], medium [2 points: 3.0–3.7 mm (TI) and 2.0–2.7 mm (colon)], and high [3 points: >3.7 mm (TI) and >2.7 mm (colon)] categories for both TI and colon. In the TI, only BWT was retained in the model, with high BWT being a significant predictor of disease activity (odds ratio [OR] 11.50, P < 0.001). In the colon, both BWT (high BWT: OR 8.63, P < 0.001) and mesenteric fat (1 point: OR 3.02, P < 0.001) were independent predictors. The pediatric Crohn disease IUS score (PCD-US) had a cutoff of 1, resulting in a sensitivity of 82% (95% confidence interval [CI]: 65%-93%) and 85% (95% CI: 80%-89%) for detecting disease activity in the TI and colon, respectively. A cutoff of 3 yielded a specificity of 88% (72%-97%) and 92% (87%-96%) for the TI and colon, respectively. Inter-observer agreement was moderate for the TI and colon (K: 0.42 and K: 0.49, respectively).
The PCD-US score was a user-friendly and reliable scoring system for assessing disease activity segmentally in pediatric CD patients. External validation was necessary before implementing this score in clinical practice.
Source: journals.lww.com/jpgn/Fulltext/2023/05000/Assessing_Disease_Activity_in_Pediatric_Crohn_s.6.aspx