Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital, Boston, MA 02115, USA.
J Pediatr Gastroenterol Nutr. 2010 Aug;51(2):155-9. doi: 10.1097/MPG.0b013e3181cb4309.
Abdominal x-rays are used diagnostically in the evaluation of children with constipation. However, their clinical utility has not been established. The aim of the study was to assess the accuracy of different methods in identifying children with functional constipation (FC) or nonretentive fecal incontinence (NRFI).
Retrospective review of abdominal x-rays in which colonic transit (CT), Barr, Leech, and fecal loading (FL) scores were blindly measured by blinded pediatric gastroenterologists and a radiologist. Children were classified a priori as FC or NRFI.
One hundred sixty patients (125 FC, 35 NRFI) were studied. There were significant differences (P < 0.05) when comparing those with FC and those with NRFI: CT: 51 +/- 18 vs 40 +/- 21 hours; Barr: 14 +/- 5 vs 11 +/- 4; Leech: 10 +/- 2 vs 8 +/- 2; FL: 2 +/- 0.5 vs 1.7 +/- 0.4. More than 20% of FC had normal Barr and Leech scores, whereas >50% of NRFI had abnormal scores. CT discriminated better between FC and NRFI. There was a significant correlation (P < 0.05) between CT and Barr (0.45), Leech (0.41) and FL scores (0.36), and between Barr and Leech scores (r = 0.94). There was good intraobserver correlation between Barr, Leech, and FL scores but poor interobserver reproducibility.
Although significant differences in overall FC and NRFI scores exist, the discriminative value is low for all scores. There is poor interobserver reproducibility of the Barr, Leech, and FL scores. These findings confirm the limited value of the plain abdominal x-ray in the evaluation of children with constipation.
腹部 X 光片在评估便秘儿童时具有诊断作用。然而，其临床实用性尚未得到证实。本研究旨在评估不同方法识别功能性便秘（FC）或非潴留性粪便失禁（NRFI）儿童的准确性。
回顾性分析了盲法测量结肠转运（CT）、Barr、Leech 和粪便负荷（FL）评分的腹部 X 光片，由盲法小儿胃肠病学家和放射科医生进行。患儿被预先分类为 FC 或 NRFI。
共研究了 160 例患儿（125 例 FC，35 例 NRFI）。FC 组与 NRFI 组相比，存在显著差异（P<0.05）：CT：51±18 小时 vs 40±21 小时；Barr：14±5 分 vs 11±4 分；Leech：10±2 分 vs 8±2 分；FL：2±0.5 分 vs 1.7±0.4 分。超过 20%的 FC 患儿 Barr 和 Leech 评分正常，而>50%的 NRFI 患儿评分异常。CT 能更好地区分 FC 和 NRFI。CT 与 Barr（0.45）、Leech（0.41）和 FL 评分（0.36）之间存在显著相关性（P<0.05），Barr 和 Leech 评分之间存在高度相关性（r=0.94）。Barr、Leech 和 FL 评分的观察者内相关性良好，但观察者间可重复性差。
尽管 FC 和 NRFI 总分存在显著差异，但所有评分的鉴别价值均较低。Barr、Leech 和 FL 评分的观察者间可重复性差。这些发现证实了腹部平片在评估便秘儿童方面的价值有限。
