Project Details

Utility and cost-effectiveness of a combination screen for pediatric lower gastrointestinal disease

Karen Queliza, MD, MS

Summary

BACKGROUND: A large proportion of pediatric colonoscopies demonstrate normal findings. This highlights the need for effective noninvasive screening tools to rule out lower gastrointestinal (GI) disease and increase the diagnostic yield of colonoscopy. Based on retrospective data at Texas Children’s Hospital (TCH), the combination of negative fecal calprotectin (FC), C-reactive protein (CRP) and stool guaiac, was superior to FC alone in ruling out abnormal colonoscopies and inflammatory bowel disease. The impact of this combination screen (FC, CRP, and stool guaiac) on limiting the number of normal colonoscopies performed on pediatric patients remains unknown. Its ability to reduce healthcare costs remains untested, as well. We hypothesize that implementation of our combination screening tool will reduce the proportion of normal colonoscopies performed in our pediatric practice, effectively attenuating healthcare expenditures. This study will retrospectively examine colonoscopy practice, FC screening and their associated costs over the past year at TCH. We will then prospectively assess the impact of our combination screen on the proportion of normal colonoscopies ordered by pediatric gastroenterologists. This research study aims to establish a strong foundation for the use of our combination test as a screening modality for lower GI pathology. Subsequent implementation of this screening tool in clinical practice may lead to optimized utilization of colonoscopy in pediatrics, maximizing patient safety and providing added benefit to society at large by limiting healthcare expenditures. BACKGROUND: A large proportion of pediatric colonoscopies demonstrate normal findings. This highlights the need for effective noninvasive screening tools to rule out lower gastrointestinal (GI) disease and increase the diagnostic yield of colonoscopy. GAP: Based on retrospective data at Texas Children’s Hospital (TCH), the combination of negative fecal calprotectin (FC), C-reactive protein (CRP) and stool guaiac, was superior to FC alone in ruling out abnormal colonoscopies and inflammatory bowel disease. The impact of this combination screen (FC, CRP, and stool guaiac) on limiting the number of normal colonoscopies performed on pediatric patients remains unknown. Its ability to reduce healthcare costs remains untested, as well. HYPOTHESIS: We hypothesize that implementation of our combination screening tool will reduce the proportion of normal colonoscopies performed in our pediatric practice, effectively attenuating healthcare expenditures. METHODS: This study will retrospectively examine colonoscopy practice, FC screening and their associated costs over the past year at TCH. We will then prospectively assess the impact of our combination screen on the proportion of normal colonoscopies ordered by pediatric gastroenterologists. RESULTS: Pending IMPACT: This research study aims to establish a strong foundation for the use of our combination test as a screening modality for lower GI pathology. Subsequent implementation of this screening tool in clinical practice may lead to optimized utilization of colonoscopy in pediatrics, maximizing patient safety and providing added benefit to society at large by limiting healthcare expenditures.