title: A clinical prediction rule and platelet count predict esophageal varices in children.
abstract: OBJECTIVE
  The validation of noninvasive tests to diagnose esophageal varices is a priority in children because repeated endoscopic evaluations are too invasive. We measured the ability of a previously developed noninvasive clinical prediction rule (CPR) to predict the presence of esophageal varices in children.
  
  
  METHODS
  We analyzed data from 108 children, younger than age 18, who received endoscopies at 8 centers, to assess portal hypertension from chronic liver disease or portal vein obstruction. Blood test and abdominal ultrasound scan results were obtained within 4 months of endoscopy. Grading of varices identified by endoscopy was confirmed by independent blinded review. Spleen size, based on data from the ultrasound scan, was expressed as a standard deviation score relative to normal values for age.
  
  
  RESULTS
  Of the children studied, 74 had esophageal varices (69%), including 35 with large varices (32%). The best noninvasive predictors of esophageal varices of any size were as follows: platelet:spleen size z-score ratio (area under the receiver operating characteristic curve [AUROC], 0.84; 95% confidence interval [CI] 0.75-0.93), CPR (AUROC, 0.80; 95% CI, 0.70-0.91), and platelet count (AUROC, 0.79; 95% CI, 0.69-0.90). The positive predictive values for the CPR and platelet count were 0.87 and 0.86, the negative predictive values were 0.64 and 0.63, the positive likelihood ratios were 3.06 and 2.76, and the negative likelihood ratios were 0.64 and 0.63, respectively. Based on positive and negative predictive values, the most accurate noninvasive tests were the CPR and platelet counts.
  
  
  CONCLUSIONS
  Noninvasive tests such as CPR and platelet count can assist in triaging children for endoscopy to identify esophageal varices.
authors.affiliation: Division of Pediatrics, Gastroenterology, Hepatology and Nutrition Unit, Pontificia Universidad Católica de Chile, Santiago, Chile. jcgana@gmail.com
authors.forename: Juan Cristóbal
authors.initials: JC
authors.lastname: Gana
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
authors.forename: Giorgina
authors.initials: G
authors.lastname: Mieli-Vergani
authors.forename: Mark
authors.initials: M
authors.lastname: Davenport
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Yaron
authors.initials: Y
authors.lastname: Avitzur
authors.forename: Jason
authors.initials: J
authors.lastname: Yap
authors.forename: Veronique
authors.initials: V
authors.lastname: Morinville
authors.forename: Herbert
authors.initials: H
authors.lastname: Brill
authors.forename: Simon C
authors.initials: SC
authors.lastname: Ling
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D007223:Infant; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D010976:Platelet Count; D011169:Portal Vein; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013154:Spleen / Q000473:pathology; D020246:Venous Thrombosis / Q000150:complications*