Screening for Biliary Atresia through QR Code Implementation

Abstract

Introduction. Biliary atresia is an inflammatory, obstructive, and idiopathic process affecting the bile ducts that leads to biliary cirrhosis. Early diagnosis and Kasai surgery offer patients the possibility of survival without requiring a liver transplant. 

Aim. To describe the implementation of a novel method of screening for biliary atresia using a quick response (QR) code at a fourth-level care hospital. 

Materials and methods. An observational, descriptive, and prospective study was carried out at the Hospital Público Materno Infantil, Salta, Argentina, between September 2022 and September 2023. During this period, the screening for biliary atresia was carried out through a survey accessible via a QR code. This survey had to be completed between 15-30 days of the life of the newborns, comparing the color of stools with a numbered colorimetric chart. The responses were categorized as “normal” and “abnormal”. Patients with abnormally colored stools were contacted by phone and scheduled for a medical consultation.

Results. A total of 6,113 live newborns were registered. 1,294 surveys were analyzed. The response rate was 21%. 57.3% of respondents completed the survey between 15 and 30 days after birth. Among the 1,294 patients surveyed, 17 recorded abnormal responses, of which one had biliary atresia and two had secondary cholestasis. The screening presented a false-positive rate of 1.1% (14/1,294). The estimated percentage of true positives from the screening was 0.2% (3/1,294). The prevalence of biliary atresia was 0.1% (1/1,294). 

Conclusion. The response rate to screening for biliary atresia using the QR code during the evaluated period was lower than that reported using colorimetric cards. Adherence increased in the last months of the program´s implementation, which requires more time for execution and dissemination. We believe that this technological innovation applied to screening could represent progress in the early detection of biliary atresia.