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Assessment of pediatric bowel and bladder dysfunction: a critical appraisal of the literature
R Jiang1, M S Kelly1, J C Routh1
1Division of Urologic Surgery, Duke University Medical Center, Durham, NC, USA.
Insights
Bowel and bladder dysfunction (BBD) diagnosis lacks standardization. This review found many questionnaires exist for pediatric BBD, but their validation methods vary, necessitating a consensus on a gold standard tool.
Area of Science:
- Pediatric Urology
- Clinical Diagnostics
Background:
- Bowel and bladder dysfunction (BBD) is a common pediatric urology condition characterized by constipation and lower urinary tract symptoms.
- Despite its prevalence and impact on patients and families, standardized clinical diagnosis for BBD remains elusive.
- Bowel and bladder dysfunction symptom questionnaires have become increasingly popular for aiding diagnosis.
Purpose of the Study:
- To summarize published BBD symptom questionnaires.
- To analyze the psychometric validation of these instruments.
Main Methods:
- A comprehensive PubMed search was conducted for BBD symptom questionnaires published since 2000.
- Search terms included 'dysfunctional elimination syndrome', 'bowel and bladder dysfunction', and related terms.
- Manual searches of conference abstracts and reference lists were also performed, with exclusion of non-English articles and those not pertaining to pediatric patients.
Main Results:
- Seven questionnaires were identified and reviewed; most demonstrated excellent discriminative properties (AUC >0.85).
- Criterion validity was not reported for any questionnaire.
- Internal consistency and responsiveness were measured in only a few studies, highlighting significant heterogeneity in psychometric testing.
Conclusions:
- Existing BBD questionnaires show variability in their psychometric validation processes.
- A consensus on a gold standard questionnaire is needed to improve the diagnosis and management of BBD in pediatric patients.
Objective:
Bowel and bladder dysfunction (BBD) is a clinical syndrome defined by the coexistence of constipation and lower urinary tract symptoms. Although BBD is a common condition in pediatric urology and can cause significant stress to patients/parents, clinical diagnosis of BBD has not been standardized. Bowel and bladder dysfunction instruments have gained popularity over the past decade to aid in diagnosis. In this review, the currently published BBD symptom questionnaires were summarized and an analysis on their psychometric validation process was provided.
Subjects/Patients:
PubMed was searched for articles on BBD symptom questionnaires/instruments/surveys since 2000. Two investigators (R.Y.J. & M.S.K.) conducted the search in duplicate. The search was limited to English language. The included search terms were 'dysfunctional elimination syndrome', 'bowel and bladder dysfunction', 'dysfunctional voiding', 'voiding dysfunction symptom score', and 'dysfunctional voiding symptom scale'. Reference lists of included studies were screened for missed studies. Unpublished abstracts presented at the following scientific meetings were also manually searched for: the American Urological Association, the Society for Pediatric Urology, and the American Academy of Pediatrics Section on Urology. Exclusion criteria included articles in languages other than English, articles not related to BBD questionnaires, and articles not pertaining to pediatric patients.
Results:
After initial search, a total of 54 articles were obtained. Of the seven questionnaires reviewed, only one did not measure sensitivity or specificity. Almost all questionnaires showed excellent discriminative property with an Area under the curve (AUC) >0.85. Criterion validity was not reported in any of the questionnaires. Known-group validation was used as a common method to evaluate construct validity. Internal consistency was reported in 2 studies, and only 1 study measured questionnaire responsiveness during initial validation.
Conclusions:
Although BBD is a common pediatric urology condition; a large amount of heterogeneity exists in the questionnaires' psychometric testing and validation process. To further improve the diagnosis and management of BBD in pediatric patients, there is a need for consensus on the gold standard questionnaire measure.
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