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Faecal impaction in children aged 0-18 years: a systematic review and metanarrative analysis of definitions used
Morris Gordon1, Amber Balda2, Samantha Arrizabalo2
1School of Medicine, University of Central Lancashire, Preston, UK Mgordon@uclan.ac.uk.
Insights
Defining faecal impaction in children with functional constipation lacks consensus. This review highlights the need for a universally accepted definition to improve clinical care and research consistency for this common condition.
Area of Science:
- Pediatric Gastroenterology
- Clinical Research Methodology
Background:
- Faecal impaction often stems from functional constipation.
- A lack of a uniform definition for faecal impaction leads to inconsistent study findings.
Purpose of the Study:
- To systematically review how trial studies define faecal impaction in children (0-18 years) with functional constipation.
- To identify criteria used and propose directions for a globally accepted definition.
Main Methods:
- A metanarrative systematic review was conducted.
- Searched CENTRAL, MEDLINE, Embase, WHO ICTR, and ClinicalTrials.gov for RCTs on faecal impaction and functional constipation in children (0-18 years) without organic causes.
- Included studies from inception to June 2024.
Main Results:
- 76 studies were included in the review.
- Only seven studies provided explicit definitions of faecal impaction.
- Clinical assessment (abdominal/rectal) was the most common definitional element, sometimes combined with radiographs.
Conclusions:
- There is a significant lack of consensus in defining faecal impaction in pediatric functional constipation.
- A unified definition is crucial for clinical, diagnostic, and prognostic consistency but is currently absent.
Background:
Faecal impaction is the result of functional constipation in the majority of cases. Surprisingly, a uniform definition for the term faecal impaction is lacking, leading to heterogeneity across study results.
Aim:
To conduct a metanarrative systematic review to ascertain how trial studies define faecal impaction among children aged 0-18 years with functional constipation.
Methods:
We conducted a systematic metanarrative review to uncover what criteria are used to define faecal impaction and to recommend directions for creating a globally accepted definition. A comprehensive literature search was conducted using prominent databases, including CENTRAL, MEDLINE, Embase, WHO ICTR (international clinical trials registry) and ClinicalTrials.gov. All relevant publications of RCTs on both faecal impaction and functional constipation from inception to June 2024, including children aged 0-18 years without underlying organic aetiology, were included.
Results:
6211 studies were screened, of which 155 were reviewed for eligibility, 76 were included in the review and five are awaiting classification. Seven studies gave an explicit definition, with three referencing a previous consensus definition. 45 studies gave an implicit definition derived from their prescreening or exclusion criteria in a larger piece of research. Clinical assessment was the most common element of definitions, with a mixture of abdominal or rectal assessments reported in 44 studies. A further six studies suggested such clinical assessments are combined with radiographs, and one study reported a definition using radiographs alone. One study reported the duration of symptoms in a definition.
Conclusion:
There is a clear lack of consensus for defining faecal impaction in children with functional constipation. Despite the clinical, diagnostic and prognostic importance of having a unified definition of faecal impaction, currently there seems to be no universally accepted definition.
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