Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods.
Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods.
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DOI：
10.1097/mpg.0b013e3181cb4309
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发表时间：
2010-08
影响因子：
2.9
通讯作者：
Nurko S
中科院分区：
文献类型：
--
作者：
Pensabene L;Buonomo C;Fishman L;Chitkara D;Nurko S
腹部X光被用于诊断便秘的儿童。然而，它们的临床应用尚未确定。目的：评价不同方法在诊断功能性便秘(FC)或非滞留性大便失禁(NRFI)儿童中的准确性。回顾腹部X线片，其中结肠传输(CT)、Barr、Leech和粪便负荷(FL)评分是由盲目的儿科胃肠病专家和放射科医生盲测的。儿童被先验地归类为FC或NRFI。共160例患者(FC 125例，NRFI 35例)。FC组与NRFI组比较，差异有统计学意义(P<；0.05)：CT：51±18 vs 40±21小时；Barr：14±5 vs 11±4；Leech：10±2 vs 8±2；FL：2±0.5 vs 1.7±0.4。超过20%的FC Barr和Leech评分正常，而50%的NRFI评分异常。CT对FC和NRFI的鉴别能力较好。CT与Barr(0.45)、Leech(0.41)与FL(0.36)、Barr与Leech(r=0.94)之间存在显著的相关性(p<；0.05)。Barr、Leech和FL分数在观察者内具有良好的相关性，但观察者间的重复性较差。虽然总体FC和NRFI分数存在显著差异，但所有分数的区分值都很低。观察者之间对Barr、Leech和FL分数的重复性很差。这些发现证实了腹部平片在评估儿童便秘方面的价值有限。
Abdominal X-rays are used diagnostically in the evaluation of children with constipation. However, their clinical utility has not been established. To assess the accuracy of different methods in identifying children with functional constipation (FC) or non-retentive fecal incontinence (NRFI). Retrospective review of abdominal x-rays in which colonic transit (CT), Barr, Leech and fecal loading (FL) scores were blindly measured by blinded pediatric gastroenterologists and a radiologist. Children were classified a priori as FC or NRFI. 160 patients (125 FC, 35 NRFI) were studied. There were significant differences (p < 0.05) when comparing those with FC and those with NRFI: CT: 51 ± 18 vs 40 ± 21 hrs; Barr: 14 ± 5 vs 11 ± 4; Leech: 10 ± 2 vs 8 ± 2; FL: 2 ± 0.5 vs 1.7 ± 0.4. Over 20% of FC, had normal Barr and Leech scores, while > 50% of NRFI had abnormal scores. CT discriminated better between FC and NRFI. There was a significant correlation (p<0.05) between CT and Barr (0.45), Leech (0.41) and FL scores (0.36), and between Barr and Leech scores (r=0.94). There was good intraobserver correlation between Barr, Leech and FL scores but poor interobserver reproducibility. While significant differences in overall FC and NRFI scores exist, the discriminative value is low for all scores. There is poor interobserver reproducibility of the Barr, Leech and FL scores. These findings confirm the limited value of the plain abdominal X-ray in the evaluation of children with constipation.