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Development of a Bowel Management Scoring Tool in Pediatric Patients with Constipation
Clara M A de Bruijn1, Shaista Safder2, Udo Rolle3
1Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Objective:
To develop a reliable and valid scoring tool, the Pediatric Bowel Management Scoring Tool (PBMST), to better guide management of constipation in pediatric patients.
Study Design:
The project comprised 2 stages, development of the questionnaire and construction of the bowel management score. Two questionnaires were created, one for children aged 8-18 years to self-report and one parent proxy-report for children aged 4-8 years. Questions regarding physical symptoms (n = 6), emotional aspects (n = 2), social activities/school (n = 1), and treatment (n = 1) were included. Patients (or parents of patients) with symptoms of constipation completed the questionnaire. The reproducibility of each question was computed using the Cohen weighted kappa coefficient (κ). A bowel management score was developed using logistic regression analysis, assessing the associations between the questions and impact on self-reported quality of life (QoL). Questions with adequate reproducibility and significantly associated with QoL were incorporated into the score.
Results:
The questionnaire was completed by 385 patients. Six questions met the inclusion criteria and were incorporated into the score: stool shape (range, 0-3 points), anorectal pain (0-4 points), abdominal pain (0-3 points), frequency of fecal incontinence (0-3 points), assistance of caregivers (0-3 points), and interference with social activities (0-6 points). Differences in bowel management scores among patients reporting no, little, some, or major impact on QoL were statistically significant (P < .001).
Conclusions:
The newly developed and validated PBMST is a reliable tool for evaluating bowel management strategies in children with constipation.
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