6234 Use of faecal calprotectin in the Primary care setting – A retrospective audit in a DGH

Objectives To assess the fate of FC tests requested from the primary care the symptoms and diagnosis made in children referred the outcome of the referrals to the clinics Methods We conducted a retrospective case note audit in Russel Hall Hospital, Dudley, West Midlands from 01/01/2022 to 31/12/2022. We recruited all the FC tests requested from the Primary care. If the tests done more than once, we made sure the child is not recruited twice. Results We analysed data of 354 case notes. {Average age 7.1 years, M: F (54:46), symptom duration 12.5 months} Main variables were FC level [<249micg/g(low FC) & >250micg/g(high FC)] and the age [0–4 years(lower), 5–10 years(middle) and >11 years(upper)]. There were 37(10%) referrals with high FC levels and 103(29%), 162(48%) & 89(25%) referrals from 0–4, 5–10 and >10 year age groups respectively. There were 63(18%) referrals to the GI clinic and 29(8%) referrals to the Paediatric clinic. In 0–4, 5–10 and >11 age groups, 16(50%), 10(77%) and 5(63%) of children with high FC were referred to clinics. Most common symptoms were abdominal pain, loose stools and bloody stools. All three features were present on 3 occasions, while two of them had high FC levels and one turned out to be IBD. Diagnoses made on each category is summarized in table 1 and the outcome of the referrals are summarized in table 2. Conclusion FC levels upto 249micg/g considered normal in children although the industrial reference is <30micg/g.¹ ² We noted significant amount of referrals in-between this range. Only 1(0.003%) child being diagnosed with IBD may indicate the insufficiency of clinical screening in primary care. Combination of three main symptoms may increase the sensitivity of the FC testing as it has shown 67% &33% association with high FC and IBD respectively. None of the referrals with low FC had IBD suggests high specificity of the test. Approximately 30% of FC levels were performed on children in lower age group where routine FC measurement is not recommended and IBD is extremely rare.³ Approximately one third of children with high FC were not referred to any clinic. Some of these children might have directly referred to tertiary centres. However, we believe this group need to be assessed by a specialist. Although, diagnosis made in GI and Paediatric clinics showed similar distribution, discharge percentages were lower in Paediatric clinics. Lowest percentages were seen in children with high FC levels. References Orfei M, Gasparetto M, Hensel KO, Zellweger F, Heuschkel RB, Zilbauer M. Guidance on the interpretation of faecal calprotectin levels in children 2021 Feb 11. C Ribes Koninckx1, E Donat1, MA Benninga2, IJ Broekaert3, F Gottrand4, LK Kolho5, P Lionetti6, E Miele7, R Orel8, A Papadopoulou9, C Pienar10, M.G Schäppi11, M Wilschanski12, N Thapar13,14. The use of faecal calprotectin testing in paediatric disorders. A position paper of the ESPGHAN Gastroenterology Committee. Neil Chanchlani and Richard K. Russell. Mistakes in paediatric inflammatory bowel disease and how to avoid them 18/01/2018.