Development and validation of a risk prediction model for functional constipation in school-aged children

Area of Science:

• Pediatric Gastroenterology
• Clinical Epidemiology
• Child Health

Background:

• Functional constipation (FC) is a common pediatric issue.
• Early identification of high-risk children is crucial for effective management.
• Existing screening tools may lack comprehensive risk factor assessment.

Purpose of the Study:

• To identify independent risk factors for functional constipation (FC) in school-aged children.
• To develop and internally validate a nomogram-based risk prediction model for early screening of FC.
• To provide a clinical tool for identifying children at high risk of functional constipation.

Main Methods:

• Retrospective, cross-sectional case-control study of 467 school-aged children.
• Development of a nomogram using multivariable logistic regression on a derivation cohort (n=326).
• Internal validation of the nomogram on an independent cohort (n=141) using ROC analysis (AUC).

Main Results:

• Identified risk factors: shorter exclusive breastfeeding, no toilet training, privacy concerns, school defecation avoidance, school stress, and poor parent-child interaction.
• Nomogram showed excellent discrimination in derivation (AUC 0.88) and validation (AUC 0.84) cohorts.
• High sensitivity (74-70%) and specificity (86-82%) were observed.

Conclusions:

• The developed nomogram is a feasible clinical tool for early FC risk identification in children.
• It integrates modifiable factors related to infant feeding, toilet training, school, and family environment.
• The nomogram aids in targeted preventive interventions for school-aged children at high risk of functional constipation.