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Diagnostic value of abdominal radiography in constipated children: a systematic review
Lieke M Reuchlin-Vroklage1, Sita Bierma-Zeinstra, Marc A Benninga
1Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
Insights
Plain abdominal radiography for diagnosing childhood constipation shows conflicting evidence. Current data does not support its routine use when clinical diagnosis is uncertain, necessitating further high-quality research.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Evidence-Based Medicine
Background:
- Childhood constipation is a prevalent condition diagnosed clinically.
- Abdominal radiography is sometimes used to confirm fecal retention when constipation diagnosis is uncertain.
Purpose of the Study:
- To evaluate the evidence linking abdominal radiography findings with constipation symptoms and signs in children.
- To assess the diagnostic accuracy of plain abdominal radiographs for childhood constipation.
Main Methods:
- A systematic literature search of MEDLINE was conducted up to April 2004.
- Included studies were assessed for methodological quality.
- A best-evidence synthesis approach was used to summarize findings from observational and controlled studies.
Main Results:
- Six studies met inclusion criteria; only two were of high methodological quality.
- Conflicting evidence exists regarding the association between clinical and radiological diagnoses of constipation.
- Limited evidence supports associations between specific clinical signs (hard stool, rebound tenderness) and radiographic findings.
Conclusions:
- The current evidence base is limited and shows conflicting results on the utility of abdominal radiography for diagnosing constipation in children.
- Routine use of plain abdominal radiography for suspected childhood constipation is not supported by current evidence.
- Further high-quality research is required to clarify the role of diagnostic imaging in pediatric constipation.
Background:
Constipation is a common problem in children. Diagnosis is based on clinical features. In case of doubt about the presence of constipation, the existence of fecal retention can be evaluated on plain abdominal radiography.
Objectives:
To describe and to assess the evidence from observational, controlled studies concerning the association between abdominal radiography and symptoms and signs related to constipation in children.
Methods:
MEDLINE was searched from inception to April 2004 using a specified search strategy. Studies that fulfilled predefined criteria were assessed for methodological quality. Study characteristics and associations were extracted and the results were summarized according to a best-evidence synthesis.
Results:
Of the 392 publications identified, 6 studies met the inclusion criteria. Only 2 studies were of high methodological quality. The best-evidence synthesis yielded conflicting evidence for an association between a clinical and a radiological diagnosis of constipation. The likelihood ratio (LR) in 2 high-quality studies was close to 1 (LR, 1.2; 95% confidence interval [CI], 1.0-1.4; and LR, 1.0; 95% CI, 0.5-1.6). Conflicting evidence was found for an association between digital rectal examination and fecal impaction on radiography. Limited evidence was found for an association between a history of hard stool and a finding of rebound tenderness and radiography (LR, 1.2; 95% CI, 1.0-1.4; and LR, 1.1; 95% CI, 1.0-1.2, respectively).
Conclusions:
The limited amount of data available shows conflicting evidence for an association between clinical symptoms of constipation and fecal loading on abdominal radiographs in children. The recommendation to perform a plain abdominal radiograph in case of doubt of the presence of constipation in a child cannot be supported. Further research of good methodological quality is needed.
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