The Peds Duct Score: A Highly Specific Predictive Model for Pediatric Choledocholithiasis

Abstract

Introduction: To determine whether adult preoperative factors predicting choledocholithiasis (CD) are reliable in children and to create a validated pediatric-specific risk model. Methods: A multicenter retrospective cohort study was performed including children (<18 yo) who underwent cholecystectomy for gallstone disease at 10 Western Pediatric Surgical Research Consortium children’s hospitals between 2016-2019. Multivariable regression analyses and ROC curves were used to determine predictive factors and optimal cutoff values for CD. The predictive model was tested with a 20% hold-out sample. Results: The cohort comprised 979 children after cholecystectomy with an average age of 14.1+3.0 years, 75.1% female, 59.2% Hispanic, BMI was 27.7+8.3. Choledocholithiasis was confirmed in 222 patients (22.7%) by MRCP, ERCP, and/or IOC. Multivariable analyses with ROC curves identified three predictive factors for CD 1) a Dilated CBD>6mm, 2) Ultrasound (US) with visualized CBD stone, and 3) Total bilirubin>1.8 mg/dL (Peds DUCT criteria). These criteria demonstrated appropriate accuracies (>76%), specificities (>78%), and negative predictive values (>79%). Other factors commonly used in adults (elevated AST/ALT, pancreatitis, BMI, and age) were not independently predictive of CD in children. When tested on a hold-out sample, higher stratified risk groups demonstrated high accuracy, specificity, and negative predictive values similar to the adult CD literature. Conclusion: Unique to children, dilated CBD>6mm, US findings of CBD stone, and total bilirubin>1.8 mg/dL are three highly-specific clinical variables predictive of choledocholithiasis. The Peds DUCT score is simple, practical, and validated on a large, multi-institutional pediatric data set and should become standard for choledocholithiasis risk assessment in children.