Interrater reliability in pediatric high-resolution anorectal manometry recordings

Area of Science:

• Pediatric Gastroenterology
• Neurogastroenterology
• Motility Disorders

Background:

• High-resolution anorectal manometry (HR-ARM) is crucial for evaluating anorectal neuromuscular function in pediatric patients with constipation or fecal incontinence.
• Previous studies have not assessed the interrater reliability of HR-ARM in pediatric populations.

Purpose of the Study:

• To evaluate the interrater reliability of pediatric high-resolution anorectal manometry (HR-ARM) assessments.
• To identify areas of agreement and disagreement among pediatric specialists in HR-ARM interpretation.

Main Methods:

• Ten pediatric gastroenterologists analyzed ten deidentified pediatric HR-ARM studies.
• Evaluated parameters included resting pressure, squeeze pressure and duration, rectoanal inhibitory reflex (RAIR), bear down maneuver, and overall interpretation.
• Statistical analysis utilized Fleiss' Kappa (κ) for categorical data and intraclass correlation coefficient (ICC) for continuous data.

Main Results:

• Excellent interrater reliability was observed for anal canal resting pressure (ICC 0.97), squeeze pressure (ICC 0.97), and squeeze duration (ICC 0.93).
• Fair agreement was found for RAIR detection (κ=0.35).
• Moderate agreement was noted for the bear down maneuver (κ=0.50) and final study interpretation (κ=0.43).

Conclusions:

• Pediatric HR-ARM demonstrates excellent reliability for quantitative pressure measurements.
• Suboptimal interrater reliability exists for the qualitative assessment of RAIR and the bear down maneuver.
• Standardization of HR-ARM protocols and interpretation criteria is essential for pediatric practice.