title: Abdominal X-ray in Pediatric Acute Severe Colitis and Radiographic Predictors of Response to Intravenous Steroids.
abstract: BACKGROUND
  Abdominal x-ray (AXR) can identify complications in acute severe colitis (ASC) and may assist in selecting high-risk children for early aggressive treatment. We aimed to describe AXR findings in pediatric ASC and to explore radiological predictors of response to intravenous corticosteroid (IVCS) therapy.
  
  
  METHODS
  A total of 56 children with ASC were included in a multicenter, retrospective 1-year cohort study (41% boys, mean age 12.1 ± 4.2). Radiographs of responders to IVCS and those requiring second-line salvage therapy by discharge were analyzed independently by 2 blinded radiologists.
  
  
  RESULTS
  A total of 33 responders to IVCS were compared with 23 nonresponders. The day-3 Pediatric Ulcerative Colitis Activity Index (PUCAI) score was significantly higher in nonresponders (63 ± 16 vs 46 ± 21, P = 0.001). The mean transverse colon luminal diameter was 30 ± 16 mm in responders and 38 ± 16 mm in nonresponders (P = 0.94). The upper range of transverse colonic diameter in children <12 years was ∼40 mm, whereas in older children it was 60 mm as accepted in adults. Ulcerations and megacolon seen on AXR were associated with nonresponse to IVCS (P = 0.006 and 0.064, respectively).
  
  
  CONCLUSIONS
  The presence of mucosal ulcerations and megacolon on AXR could be considered in the risk stratification of children with ASC for early aggressive treatment, together with the previously known day-3 and day-5 Pediatric Ulcerative Colitis Activity Index scores, albumin, and C-reactive protein.
authors.affiliation: *Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center †Hebrew University of Jerusalem, Jerusalem, Israel ‡Alder Hey Children's NHS Foundation Trust, Liverpool, UK §Children's Hospital of Eastern Ontario IBD Centre ||Department of Pediatrics, University of Ottawa, Ottawa, Canada ¶Connecticut Children's Medical Center, Hartford, CT #Nationwide Children's Hospital, Ohio State University, Columbus **SickKids Hospital, University of Toronto, Toronto, Canada.
authors.forename: Alina
authors.initials: A
authors.lastname: Livshits
authors.forename: Drora
authors.initials: D
authors.lastname: Fisher
authors.forename: Irith
authors.initials: I
authors.lastname: Hadas
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.forename: David
authors.initials: D
authors.lastname: Mack
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hyams
authors.forename: Wallace
authors.initials: W
authors.lastname: Crandall
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Dan
authors.initials: D
authors.lastname: Turner
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000418:Albumins / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D002648:Child; D003092:Colitis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology*; D044684:Colon, Transverse / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008531:Megacolon / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011860:Radiography, Abdominal / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014965:X-Rays
chemical_list: D000305:Adrenal Cortex Hormones; D000418:Albumins; D002097:C-Reactive Protein