title: The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Fecal calprotectin (FC) is increasingly used during the diagnosis of inflammatory bowel disease (IBD), outperforming blood markers during investigation in children. Tests that reduce endoscopy rates in children with suspected gut inflammation would be beneficial. We aimed to determine the usefulness of FC in children undergoing their primary investigation for suspected IBD by systematic review and meta-analysis.
  
  
  METHODS
  An electronic search was performed with keywords relating to IBD and calprotectin in multiple electronic resources from 1946 to May 2012; a hand search was also performed. Inclusion criteria were studies that reported FC levels before the endoscopic investigation of IBD in patients less than 18 years old. Studies were evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool, and a meta-analysis was performed using a hierarchical summary receiver operating curve model.
  
  
  RESULTS
  Eight papers met the inclusion criteria (six prospective and two retrospective case-control studies); methodological quality was determined in detail for each study. The 8 studies presented FC levels at presentation in 715 patients, 394 pediatric IBD patients, and 321 non-IBD controls. Pooled sensitivity and specificity for the diagnostic utility of FC during the investigation of suspected pediatric IBD were 0.978 (95% confidence interval (CI), 0.947-0.996) and 0.682 (95% CI, 0.502-0.863), respectively; the positive and negative likelihood ratios were 3.07 and 0.03, respectively.
  
  
  CONCLUSIONS
  FC has a high sensitivity and a modest specificity during the diagnosis of suspected pediatric IBD. Further work is required to determine the effect of FC levels on endoscopy rates and its role during the re-evaluation of those with confirmed disease.
authors.affiliation: 1] Child Life and Health, University of Edinburgh, Edinburgh, UK [2] Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Henderson
authors.affiliation: Centre for Population Health Sciences, Medical School, Edinburgh, UK.
authors.forename: Niall H
authors.initials: NH
authors.lastname: Anderson
authors.affiliation: 1] Child Life and Health, University of Edinburgh, Edinburgh, UK [2] Department of Paediatric Gastroenterology, Royal Hospital for Sick Children, Edinburgh, UK.
authors.forename: David C
authors.initials: DC
authors.lastname: Wilson
mesh_terms: D001499:Bayes Theorem; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D005243:Feces / Q000737:chemistry*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis* / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008390:Markov Chains; D015233:Models, Statistical; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex