Comparison of pre-operative Hirschsprung-associated enterocolitis using classical criteria and Delphi method: A diagnostic study

BACKGROUND: Hirschsprung-associated enterocolitis (HAEC) is the most common complication of Hirschsprung disease (HSCR) that may happen pre-operatively. Several methods have been reported to determine HAEC. Because the diagnosis of pre-operative HAEC might change the surgical plan, we aimed to determine the accuracy of the classical criteria for diagnosis of pre-operative HAEC and using the Delphi method as a gold standard. METHODS: Medical records of HSCR children who were admitted to our hospital from January 2009 to December 2015 were retrospectively analyzed. RESULTS: Ninety-six subjects were involved in this study, consisting of 74 males and 22 females. The most common findings of the Delphi score were abdominal distension (100%) and dilated loops of bowel (100%), followed by leucocytosis (78.6%), lethargy (71.4%), cutoff sign in rectosigmoid with absence of distal air (71.4%), and shift to left (71.4%). The frequency of pre-operative HAEC was 4.2% and 14.6% using the classical criteria and Delphi method, respectively (p = 0.016). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rates of the classical criteria for diagnosis of pre-operative HAEC were 14.3% (95% CI: 1.8–42.8%), 97.6% (95% CI: 91.5–99.7%), 50% (95% CI: 13.3–86.7%), 87% (95% CI: 84.3–89.2), and 85.4% (95% CI: 76.7–91.8%), respectively. CONCLUSIONS: The frequency of pre-operative HAEC is low in our hospital. The accuracy of the classical criteria is considered relatively moderate for diagnosis of pre-operative HAEC.