Diagnostic Accuracy of Fecal Calprotectin for Pediatric Inflammatory Bowel Disease in Primary Care: A Prospective Cohort Study.
In specialist care, fecal calprotectin (FCal) is a commonly used noninvasive diagnostic test for ruling out inflammatory bowel disease (IBD) in children with chronic gastrointestinal symptoms. The aim of this study was to evaluate the diagnostic accuracy of FCal for IBD in symptomatic children in primary care.



We studied 2 prospective cohorts of children with chronic diarrhea, recurrent abdominal pain, or both: children initially seen in primary care (primary care cohort) and children referred to specialist care (referred cohort). FCal (index test) was measured at baseline and compared with 1 of the 2 reference standards for IBD: endoscopic assessment or 1-year follow-up. Physicians were blinded to FCal results, and values greater than 50 μg/g feces were considered positive. We determined specificity in the primary care cohort and sensitivity in the referred cohort.



None of the 114 children in the primary care cohort ultimately received a diagnosis of IBD. The specificity of FCal in the primary care cohort was 0.87 (95% CI, 0.80-0.92). Among the 90 children in the referred cohort, 17 (19%) ultimately received a diagnosis of IBD. The sensitivity of FCal in the referred cohort was 0.99 (95% CI, 0.81-1.00).



The findings of this study suggest that a positive FCal result in children with chronic gastrointestinal symptoms seen in primary care is not likely to be indicative of IBD. A negative FCal result is likely to be a true negative, which safely rules out IBD in children in whom a primary care physician considers referral to specialist care.
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Gea A
GA
Holtman
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Yvonne
Y
Lisman-van Leeuwen
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Boudewijn J
BJ
Kollen
Department of Pediatrics, Isala Hospital, Zwolle, The Netherlands.
Obbe F
OF
Norbruis
Department of Pediatric Gastroenterology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.
Johanna C
JC
Escher
Department of Pediatric Gastroenterology, Emma Children's Hospital ⁄ Academic Medical Center, Amsterdam, The Netherlands.
Angelika
A
Kindermann
Department of Clinical Chemistry, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Yolanda B
YB
de Rijke
Department of Pediatric Gastroenterology, Beatrix Children's Hospital ⁄ University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Patrick F
PF
van Rheenen
Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands m.y.berger@umcg.nl.
Marjolein Y
MY
Berger
D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D002648:Child; D003113:Colonoscopy; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000209:etiology; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D009426:Netherlands; D011320:Primary Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012680:Sensitivity and Specificity
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex
calprotectin; child; inflammatory bowel disease; practice-based research; primary health care; sensitivity and specificity