Reuchlin-Vroklage Lieke M, Bierma-Zeinstra Sita, Benninga Marc A, Berger Marjolein Y
Department of General Practice, Erasmus Medical Centre, Rotterdam, The Netherlands.
Arch Pediatr Adolesc Med. 2005 Jul;159(7):671-8. doi: 10.1001/archpedi.159.7.671.
Constipation is a common problem in children. Diagnosis is based on clinical features. In case of doubt about the presence of constipation, the existence of fecal retention can be evaluated on plain abdominal radiography.
To describe and to assess the evidence from observational, controlled studies concerning the association between abdominal radiography and symptoms and signs related to constipation in children.
MEDLINE was searched from inception to April 2004 using a specified search strategy. Studies that fulfilled predefined criteria were assessed for methodological quality. Study characteristics and associations were extracted and the results were summarized according to a best-evidence synthesis.
Of the 392 publications identified, 6 studies met the inclusion criteria. Only 2 studies were of high methodological quality. The best-evidence synthesis yielded conflicting evidence for an association between a clinical and a radiological diagnosis of constipation. The likelihood ratio (LR) in 2 high-quality studies was close to 1 (LR, 1.2; 95% confidence interval [CI], 1.0-1.4; and LR, 1.0; 95% CI, 0.5-1.6). Conflicting evidence was found for an association between digital rectal examination and fecal impaction on radiography. Limited evidence was found for an association between a history of hard stool and a finding of rebound tenderness and radiography (LR, 1.2; 95% CI, 1.0-1.4; and LR, 1.1; 95% CI, 1.0-1.2, respectively).
The limited amount of data available shows conflicting evidence for an association between clinical symptoms of constipation and fecal loading on abdominal radiographs in children. The recommendation to perform a plain abdominal radiograph in case of doubt of the presence of constipation in a child cannot be supported. Further research of good methodological quality is needed.
便秘是儿童常见问题。诊断基于临床特征。若对是否存在便秘存疑，可通过腹部平片评估是否存在粪便潴留。
描述并评估观察性对照研究中有关儿童腹部平片与便秘相关症状和体征之间关联的证据。
使用特定检索策略对MEDLINE自起始至2004年4月的数据进行检索。对符合预定义标准的研究进行方法学质量评估。提取研究特征和关联信息，并根据最佳证据综合法进行结果总结。
在检索到的392篇出版物中，6项研究符合纳入标准。仅2项研究方法学质量高。最佳证据综合法得出的关于便秘临床诊断与放射学诊断之间关联的证据相互矛盾。2项高质量研究中的似然比（LR）接近1（LR为1.2；95%置信区间[CI]为1.0 - 1.4；以及LR为1.0；95%CI为0.5 - 1.6）。对于直肠指检与腹部平片上粪便嵌塞之间的关联，证据相互矛盾。对于硬便史与反跳痛及腹部平片检查结果之间的关联，证据有限（LR分别为1.2；95%CI为1.0 - 1.4；以及LR为1.1；95%CI为1.0 - 1.2）。
现有数据有限，显示儿童便秘临床症状与腹部平片上粪便负荷之间关联的证据相互矛盾。不支持在怀疑儿童存在便秘时进行腹部平片检查的建议。需要开展方法学质量良好的进一步研究。
