Vogel L, Samdani A, Chafetz R, Gaughan J, Betz R, Mulcahey M J
Shriners Hospitals for Children, Chicago, IL, USA.
Spinal Cord. 2009 Sep;47(9):687-91. doi: 10.1038/sc.2008.180. Epub 2009 Feb 3.
Intra-rater reliability study, cross-sectional design.
To report on the intra-rater agreement of the anorectal examinations and classification of injury severity in children with spinal cord injury (SCI).
Two, non-profit children's hospitals specializing in pediatric SCI.
180 subjects had at least two trials of the anorectal examinations as defined by the International Standards for Neurological Classification of Spinal Cord Injury. Intraclass correlation coefficients (ICC) and 95% confidence intervals (CI) were used to evaluate the agreement. ICC>0.90=high agreement; ICC between 0.75-0.89=moderate agreement; ICC<0.75=poor agreement.
When evaluated for the entire sample, agreement was moderate-high for anal sensation and contraction and injury classification. When evaluated as a function of age at examination and type of injury, agreement for anal sensation was poor for subjects with tetraplegia in the 12-15-year age group (ICC=0.56) and 16-21-year age group (ICC=0.70) and for subjects with paraplegia in the 6-11-year age group (ICC=0.69). Agreement for anal contraction was moderate for subjects with tetraplegia in the 16-21-year age group (ICC=0.81) and subjects with paraplegia in the 12-15-year age group (ICC=0.78) and poor for subjects with paraplegia in the 6-11-year age group (ICC=0.67). Agreement for injury classification was poor for subjects with tetraplegia in the 12-15-year group (ICC=0.56) and 16-21-year group (ICC=0.74) and paraplegia in the 6-11-year group (ICC=0.11) and 12-15-year group (ICC=0.63). Anorectal responses had high agreement in subjects with tetraplegia in the 6-11-year group and moderate to high agreement in subjects with paraplegia in the 16-21-year group.
The data do not fully support the use of anorectal examination in children. Further work is warranted to establish the validity of anorectal examination.
评估者内信度研究，横断面设计。
报告脊髓损伤（SCI）患儿肛门直肠检查的评估者内一致性及损伤严重程度分类情况。
两家专门治疗小儿脊髓损伤的非营利性儿童医院。
180名受试者按照脊髓损伤神经学分类国际标准进行了至少两次肛门直肠检查。使用组内相关系数（ICC）和95%置信区间（CI）评估一致性。ICC>0.90为高度一致；ICC在0.75 - 0.89之间为中度一致；ICC<0.75为一致性差。
对整个样本进行评估时，肛门感觉、收缩及损伤分类的一致性为中度偏高。按照检查时的年龄和损伤类型进行评估时，12 - 15岁组和16 - 21岁组的四肢瘫受试者、6 - 11岁组的截瘫受试者的肛门感觉一致性较差（ICC分别为0.56、0.70和0.69）。16 - 21岁组的四肢瘫受试者、12 - 15岁组的截瘫受试者的肛门收缩一致性为中度（ICC分别为0.81和0.78），6 - 11岁组的截瘫受试者的肛门收缩一致性较差（ICC = 0.67）。12 - 15岁组和16 - 21岁组的四肢瘫受试者、6 - 11岁组和12 - 15岁组的截瘫受试者的损伤分类一致性较差（ICC分别为0.56、0.74、0.11和0.63）。6 - 11岁组的四肢瘫受试者的肛门直肠反应一致性高，16 - 21岁组的截瘫受试者的肛门直肠反应一致性为中度偏高。
数据并不完全支持在儿童中使用肛门直肠检查。有必要开展进一步工作以确定肛门直肠检查的有效性。
