Development of a symptom score for dysfunctional elimination syndrome

Dysfunctional elimination syndrome is a heterogeneous syndrome with no widely accepted diagnostic criteria. Previously developed questionnaires provide incomplete psychometric assessment. We developed a discriminative questionnaire for diagnosing dysfunctional elimination syndrome and assessed its validity and reliability.

A 14-item 5-point Likert scale questionnaire was devised using literature review, expert opinions and patient input. The questionnaire was administered to 62 children 4 to 16 years old (median age 8) clinically diagnosed with dysfunctional elimination syndrome by a pediatric urologist, of whom 71% were female. It was also administered to 50 healthy controls 4 to 16 years old (median age 7), of whom 66% were female. Children with structural abnormalities were excluded from study. To assess reliability 50 participants were asked to complete the questionnaire again 1 week later.

Median total score in cases and controls was 14 of 52 (range 4 to 30) and 6 of 52 (range 1 to 13), respectively. The difference was statistically significant (p = 0.001). Discriminant function analysis showed 80% accuracy. ROC curve showed a score of 11 as the optimum threshold with an AUC of 0.903 (95% CI 0.814-0.948). Test-retest reliability was 84.5% (p = 0.001). Factor analysis showed unloading on 4 factors, corresponding to urinary incontinence, urgency, obstructive symptoms and constipation/fecal soiling. Of participants 85% classified the questionnaire as very easy or easy to complete.

This new questionnaire is valid and reliable for diagnosing dysfunctional elimination syndrome. It can be used as a clinical or research instrument.