Inter and Intraobserver Variation in Interpretation of Fecal Loading on Abdominal Radiographs.

Area of Science:

• Pediatric Gastroenterology
• Radiology
• Medical Diagnostics

Background:

• The ROME IV criteria are the gold standard for diagnosing functional constipation.
• Current guidelines from ESPGHAN and NASPGHAN do not recommend abdominal X-rays for constipation diagnosis.
• Despite recommendations, abdominal radiography is frequently used for diagnosing constipation.

Purpose of the Study:

• To evaluate inter-observer and intra-observer variation in the interpretation of fecal loading on abdominal radiographs in children.
• To assess the reliability and reproducibility of using abdominal X-rays for diagnosing and grading constipation.

Main Methods:

• 100 children's abdominal radiographs from emergency room visits for gastrointestinal symptoms were reviewed.
• Four physicians each from gastroenterology, radiology, and emergency medicine independently interpreted radiographs subjectively and objectively (Barr and Blethyn scoring systems).
• Inter- and intra-observer agreement was evaluated using the Kappa coefficient (k).

Main Results:

• Subjective interpretations showed poor agreement among observers (k=0.18).
• Intra-observer agreement varied significantly, ranging from poor (k=0.08) to fair (k=0.61).
• Objective scoring using the Blethyn system also indicated poor agreement (k=0.14).

Conclusions:

• The reliability and reproducibility of abdominal X-rays for diagnosing and grading constipation are questionable due to poor to fair agreement.
• The findings support current ESPGHAN and NASPGHAN recommendations against using abdominal X-rays for constipation diagnosis in children.