A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia

• Published in: Pediatric surgery international 2024-08, Vol.40 (1), p.244, Article 244
• Main Authors: Mahat, Nooraini, Chiang, Li Wei, Chen, Yong, Razak, Nazrul Hadi Abdul, Abdullah, Mohd Yusof, Sanmugam, Anand, Singaravel, Srihari, Soe, Htoo Htoo Kyaw, Nah, Shireen Anne
• Format: Article
• Language: English
• Subjects: Biliary Atresia - complications; Biliary Atresia - diagnosis; Biliary Atresia - surgery; Cholangiography - methods; Cross-Sectional Studies; Early Diagnosis; Female; gamma-Glutamyltransferase - blood; Humans; Infant; Infant, Newborn; Jaundice, Obstructive - diagnosis; Jaundice, Obstructive - etiology; Male; Medicine; Medicine & Public Health; Original Article; Pediatric Surgery; Pediatrics; Performance evaluation; Prospective Studies; Sensitivity and Specificity; Surgery
• ISSN: 1437-9813; 0179-0358; 1437-9813
• DOI: 10.1007/s00383-024-05830-w

Purpose Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA. Methods We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021–December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0–6), consists of gall bladder length  0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2). Results 73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%. Conclusion The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.