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Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing
Isha Kaul1, Vincent S Staggs2,3, Amber Bagherian4
1Section of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Insights
Pediatric gastroenterologists showed better agreement on Rome IV diagnoses for functional gastrointestinal disorders (FGIDs) than on diagnostic testing. Adherence to Rome criteria reduced unnecessary tests.
Area of Science:
- Pediatric Gastroenterology
- Clinical Diagnosis
- Medical Practice Evaluation
Background:
- Childhood functional gastrointestinal disorders (FGIDs) are diagnosed using Pediatric Rome IV criteria.
- Physician agreement on FGID diagnosis and diagnostic testing is crucial for consistent patient care.
- Previous studies highlighted variability in FGID diagnosis and management.
Purpose of the Study:
- To assess inter-rater and intra-rater agreement among pediatric gastroenterologists using the Pediatric Rome IV criteria for FGID diagnosis.
- To evaluate agreement on diagnostic testing strategies for pediatric FGIDs.
- To identify factors influencing diagnostic variability in pediatric FGID management.
Main Methods:
- A survey with clinical FGID vignettes was administered to pediatric gastroenterologists and fellows at two medical centers.
- Participants identified Rome IV diagnoses and selected diagnostic tests for each vignette.
- The survey was repeated within 3 months to assess intra-rater reliability; agreement was calculated using weighted percentages.
- Linear mixed modeling analyzed sources of variability in diagnostic testing decisions.
Main Results:
- Overall inter-rater agreement on Rome IV diagnoses was 68%, with intra-rater agreement at 76%.
- Agreement on diagnostic testing was significantly lower, with inter-rater agreement below 30% and intra-rater agreement at 57%.
- Between-physician variability accounted for 43% of differences in diagnostic test selection; using Rome criteria correlated with fewer tests.
Conclusions:
- Pediatric Rome IV diagnostic agreement among physicians is higher than for previous criteria and notably higher than agreement on diagnostic testing.
- Significant variability exists in diagnostic testing for pediatric FGIDs, suggesting a need for standardized approaches.
- Further research and guideline refinement may improve consistency in diagnostic testing for pediatric FGIDs.
Background:
Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs.
Methods:
Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re-administered within 3 months. Inter-rater and intra-rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing.
Key Results:
Thirty-four raters completed the initial survey of whom thirty-one (91%) completed the repeat survey. Overall inter-rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra-rater agreement was 76%. In contrast, overall inter-rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra-rater agreement was only 57%. Between-physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2-2.0, p = 0.015). Higher intra-rater agreement was noted for diagnostic testing in faculty when compared to fellows (p = 0.009).
Conclusions & Inferences:
In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing.
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