Background Several groups have proposed models to predict disease outcomes in pediatric Crohn’s disease (CD), notably the RISK, GROWTH, and the Porto group, but none were externally validated. We aimed to explore these predictive models and individual predictors summarized by the PIBD-ahead project in a prospective inception cohort of pediatric CD. Methods We included children who were diagnosed with CD at two medical centers and followed them at 3 and 12 months thereafter as well as at the last follow-up . Outcomes included steroid-free remission (SFR), surgery and stricturing/fistulizing disease Results 155 children were included (median follow-up of 31 [16–48] months, 107 [71%] had moderate-to-severe disease). Stricturing and penetrating disease at diagnosis were noted in 34 (22%) and two (1.3%) children, respectively, and these were excluded from the relevant analyses. At 1 year, 10 (8.3%) developed new stricturing disease, two (1.7%) developed penetrating disease, seven (5%) required intestinal surgery, and 15 (10%) required perianal surgery. The sensitivity/specificity/PPV/NPV of the GROWTH criteria for predicting SFR at 12 months (occurring in 70% of children) were 20%/85%/76%/31% and for surgery at two years 96%/20%/16%/96%. Strictures were predicted by the RISK model with sensitivity/specificity/PPV/NPV of 33%/73%/18%/86%. The sensitivity/specificity/PPV/NPV of the Porto criteria to predict surgery were 86%/10%/4%/94%. None of the PIBD-ahead predictors were associated with surgery or stricturing disease. Conclusion None of the three main predictive models in pediatric CD achieved sufficient accuracy, far from that reported in the original cohorts. This highlights the necessity of external validation in any prediction model prior to its implementation in clinical practice.
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