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Abdominal radiograph in the assessment of fecal impaction in children with functional constipation: comparing three
Tatyana Borges da Cunha1, Soraia Tahan, Maria Fátima de Faria Soares
1Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
Insights
Radiological scores like the Barr score effectively assess fecal impaction in children with constipation and treatment response. However, these scores do not correlate with total colonic transit time.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Clinical Assessment
Background:
- Fecal impaction is a common complication of chronic constipation in children.
- Radiological assessment plays a role in diagnosing fecal impaction.
- Standardized scoring systems are needed to evaluate impaction and treatment efficacy.
Purpose of the Study:
- To compare the diagnostic accuracy and interobserver reliability of three radiological scores (Barr, Blethyn, Leech) for fecal impaction in children.
- To evaluate the utility of these scores in assessing the effectiveness of fecal disimpaction therapy.
- To determine the relationship between radiological scores and total colonic transit time (TCT).
Main Methods:
- 123 abdominal radiographs of children with constipation were analyzed independently by three observers using Barr, Blethyn, and Leech scores.
- Interobserver agreement was calculated using the kappa coefficient.
- Radiological scores were assessed before and after fecal disimpaction in 30 patients, and TCT was measured in 59 patients using radiopaque markers.
Main Results:
- Good interobserver agreement was observed for the Barr and Leech scores, while the Blethyn score showed lower agreement.
- Barr and Leech scores demonstrated good correlation.
- A statistically significant reduction in scores was noted after fecal disimpaction, particularly with the Barr score (p < 0.001).
- No significant correlation was found between any radiographic score and TCT.
Conclusions:
- Plain abdominal radiography is a useful tool for diagnosing fecal impaction in children.
- The Barr score is a reliable method for assessing fecal impaction and its response to disimpaction therapy.
- Radiographic assessment of fecal impaction is not related to total colonic transit time.
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.
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