Abdominal radiograph in the assessment of fecal impaction in children with functional constipation: comparing three scoring systems

Abstract

Objectives: To compare three radiological scores in the study of fecal impaction in children with constipation. To investigate whether these radiological scores are useful in the assessment of fecal disimpaction therapy and if they present a relation with total colonic transit time. Methods:The Barr, Blethyn and Leech scores were measured by three observers, independently, in 123 abdominal radiographs. Interobserver agreement in the diagnosis of fecal impaction was calculated for the three scores. In 30 radiographs, the analysis of the scores was performed before and after fecal disimpaction. Total colonic transit time was calculated in 59 radiographs with the use of radiopaque markers. Results:The agreement between pairs of observers was assessed by the kappa coefficient and was good for the Barr (0.56, 0.59 and 0.69) and Leech scores (0.53, 0.58 and 0.61). The Blethyn score presented lower kappa coefficients (0.26, 0.32 and 0.36). In the comparison of methods, Leech and Barr showed a good correlation. After fecal disimpaction, there was a statistically significant reduction (p < 0.001) of scores, most significantly with the Barr score. There was no relation between radiographic scores and colonic transit time. Conclusions:There is no relation between fecal impaction assessed by radiography of the abdomen and total colonic transit time. Plain radiographs may be a useful tool for the diagnosis of fecal impaction. The Barr score can be considered a good method of analysis, especially to assess the response to treatment of fecal impaction. J Pediatr (Rio J). 2012;88(4):317-22:Intestinal constipation, fecal impaction, abdominal radiograph, methods, child. ResumoObjetivos: Comparar três escores radiológicos na pesquisa de impactação fecal em crianças com constipação intestinal. Verificar, ainda, se estes escores radiológicos são úteis na avaliação da terapia de desimpactação fecal e se apresentam relação com o tempo de trânsito colônico total.Material e métodos: Os escores de Barr, Blethyn e Leech foram aferidos por três observadores, de forma independente, em 123 radiografias de abdome. A concordância interobservador no diagnóstico da impactação fecal foi calculada para os três escores. Em 30 radiografias, foi feita a análise dos escores antes e após a desimpactação fecal. O tempo de trânsito colônico total foi calculado em 59 radiografias com o emprego de marcadores radiopacos.Resultados: A concordância entre os pares de observadores, avaliada pelo coeficiente de Kappa, foi boa para os escores de Barr (0,56, 0,59 e 0,69) e Leech (0,53, 0,58 e 0,61). O escore de Blethyn apresentou menores coeficientes de Kappa (0,26, 0,32 e 0,36). Na comparação dos métodos, Leech e Barr mostraram boa correlação. Após a desimpactação fecal, houve redução estatisticamente significante (p < 0,001) dos escores, mais expressiva com o escore de Barr. Não houve relação entre os escores radiológicos e o tempo de trânsito colônico. Conclusões:Não há relação entre impactação fecal avaliada pela radiografia de abdome e o tempo de tr...

Reliability of Barr, Leech, and Blethyn Score in Using of Plain Radiography in Determining Fecal Impaction in Children With and Without Constipation

“…If score >11, sensitivity and specificity was 83% and 79% respectively. Another study recommended Barr score as a useful in diagnosis and also response to treatment of fecal impaction in children (7) . In the study by Beckmann et al, sensitivity and specificity was 77% and 35% respectively (2) .…”

Development, reliability and validation of a neurogenic bowel dysfunction score in pediatric patients with spina bifida

“…The experts collaborated to generate a domain of observables regarding constipation causes and effects in the pediatric spina bifida population. The content was generated from their experiences and knowledge, as well as from other pertinent questionnaires used to assess constipation or fecal incontinence in other populations, evidence based information on neurogenic bowel, and the Rome III Criteria for constipation …”

“…Patients with neurogenic bowel dysfunction have lower quality of life expression . In the pediatric patient, decreased quality of life due to chronic constipation or fecal incontinence caused by neurogenic bowel can cause emotional, physical, and psychological distress . It may also be the cause of increased school absences, social discrimination, and low self‐esteem …”

Prospective evaluation of Peristeen® transanal irrigation system with the validated neurogenic bowel dysfunction score sheet in the pediatric population

“…Those with NGBo frequently suffer decreased quality of life expression, depression, social discrimination, school absences, constipation, and fecal incontinence . Poor NGBo control can lead to emotional, physical and psychological distress . Decreased quality of life affects the families and caregivers of children with SB .…”

“…5 Poor NGBo control can lead to emotional, physical and psychological distress. 6 Decreased quality of life affects the families and caregivers of children with SB. 7,8 Eighty percent of those with SB need to be utilizing some form of a bowel program in order to manage their symptoms and gain social continence.…”