275 Routinecontrastenemapriortostomareversalseemsonlyrequiredfollowingtreatmentfornecrotizingenterocolitis:Anevaluationofthediagnosticaccuracyofthecontrastenema Chapter 13 Statistical analysis The diagnostic accuracy of the contrast enema was presented by means of the tests sensitivity, specificity, positive predictive value, negative predictive value and area under the curve (AUC) from the receiver operator curve (ROC) with 95%-confidence interval (95%-CI). This was evaluated for the whole cohort as well as for patients treated for necrotizing enterocolitis only. Descriptive characteristics were reported as median with interquartile range in case of non-normally distributed variables or mean ± standard deviation (SD) in normally distributed variables. All analyses were performed with IBM SPSS statistics, version 23 (IBM Corp., Armonk, NY, United States). Results A total of 389 young children were treated with an intestinal stoma in our institute during the study period. A total of 165 patients were excluded of which 126 patients treated for anorectal malformations, 37 patients that died before stoma reversal and two patients who had stoma reversal in a different hospital leaving 224 patients to be included in our analysis. Patients in our cohort were treated for; necrotizing enterocolitis (NEC) (N=94/224, 42%), Hirschsprung disease (N=58/224, 26%), intestinal atresia (N=30/224, 13%), meconium ileus (N=21/224, 9%), meconium peritonitis (N=10/224, 4%), gastroschisis with intestinal atresia (N=7/224, 3%), focal intestinal perforation (FIP) (N=5/224, 2%). The characteristics of all patients undergoing stoma reversal are presented in Table 1. The overall follow-up was a median of 32 months (IQR: 10 – 95 months). Gold standard strictures identified during surgery Following our gold standard, 24 strictures were found and treated during either stoma reversal or redo-surgery in 23 patients which is 10% (N=23/224) of the overall cohort. One patient treated with an intestinal atresia in the duodenum, complicated by a volvulus resulting in stoma formation due to intestinal ischemia, had two strictures which were both identified by contrast enema but treated in two different operations. 96% (N=22/23) of the patients who developed a stricture had a history of NEC. Out of all strictures, 88% (N=21/24) were found during stoma reversal and 12% (N=3/23) during redo-surgery within three months following stoma reversal. Three strictures were excluded from the analysis of the diagnostic accuracy of the contrast enema. Reasons for exclusion of these strictures were no enema performed prior to stoma reversal, an inconclusive enema and blockage of contrast by a primary stricture which resulted in a missed second, more distal, stricture during redo-surgery.
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