Radiographic Scale Helps Diagnose Necrotizing Enterocolitis

A new study describes a radiographic assessment scale developed to help clinicians predict disease severity in infants with necrotizing enterocolitis (NEC).

Researchers at Duke University Medical Center (Duke, Durham, NC, USA) developed the Duke abdominal assessment scale (DAAS) radiographic scale, a standardized 10-point radiographic scale that increases with disease severity; for every one point increase in the DAAS score, patients are more likely to have severe disease, and are more likely to need a surgical intervention. To validate the scale, the researchers performed a case-control study of 43 infants to assess whether the DAAS scale could serve as a clinically useful tool; a control group consisted of 86 patients with suspected NEC who did not undergo surgery. The DAAS scores were assigned by two pediatric radiologists with 20 and 6 years' experience. The researchers found that patients with higher DAAS scores were more likely to undergo surgical intervention than patients with lower scores are. An analysis showed good overall performance for predicting eventual surgical intervention in the study group with higher DAAS scores. The study was published in the November 2009 issue of the American Journal of Roentgenology (AJR).

"Our study suggests that using the DAAS score when interpreting abdominal X-rays in neonates and infants with clinically suspected NEC may help guide increased level of clinical concern and monitoring for advanced NEC,” said lead author Caroline Hollingsworth, M.D. "Radiographic monitoring of disease progression and heightened clinical awareness through improved communication via the DAAS system has been a tremendous help to our clinicians at Duke.”

NEC is a serious disease that causes infection and inflammation of the intestines in infants, primarily those that are premature. Its cause is unknown, however, it is one of the leading causes of surgical intervention in preemies and has a death rate of 25%. Radiographic signs of NEC include dilated bowel loops, paucity of gas, a "fixed loop" (unaltered gas-filled loop of bowel), portal venous gas, and pneumoperitoneum (extraluminal or "free air" outside the bowel within the abdomen); the pathognomic finding on plain films is pneumatosis intestinalis.

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