Division of Urology, Children's Memorial Hospital, Chicago, Illinois 60614, USA.
J Urol. 2010 Oct;184(4 Suppl):1692-8. doi: 10.1016/j.juro.2010.05.054. Epub 2010 Aug 21.
Currently to our knowledge no validated reliable tools are available to evaluate constipation in children. Abdominal x-rays are often done in clinical practice to evaluate patients with lower urinary tract symptoms. Although 3 previously published rating tools exist to score constipation based on x-ray, there is little information on their merits. We assessed these 3 tools for reliability among multiple practitioners.
We retrospectively analyzed abdominal x-rays in a cohort of 80 patients between ages 4 and 12 years. X-rays were independently assessed by each of us using the previously published Barr, Leech and Blethyn scoring tools. Scores were analyzed for reliability using standard statistical methods.
The range of weighted κ score, indicating reliability, were 0.0491 to 0.4809 for the Barr, 0.1195 to 0.2730 for the Leech and 0.0454 to 0.4514 for the Blethyn method. Guidelines for κ scores are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-marginal reproducibility. ICC, another reliability measure, was 0.02577 for the Barr, 0.3313 for the Leech and 0.201 for the Blethyn method. ICC interpretations are greater than 0.75-excellent, 0.4 to 0.75-good and 0 to 0.4-poor. There was a trend toward good interrater reliability between more experienced urology practitioners with the Barr and Blethyn tools (0.48 and 0.45, respectively) but not between less experienced raters or with the Leech tool.
Currently available scoring tools to evaluate constipation by x-ray do not have good reliability among multiple examiners. Further research is needed to develop an alternate tool to increase the reliability of x-ray to assess constipation between multiple raters.
据我们所知，目前尚无经过验证的可靠工具可用于评估儿童的便秘。在临床实践中，经常进行腹部 X 光检查以评估下尿路症状患者。尽管已经发表了 3 种先前的评分工具，可根据 X 射线评估便秘，但关于其优点的信息却很少。我们评估了这 3 种工具在多位从业人员中的可靠性。
我们回顾性地分析了 80 名年龄在 4 至 12 岁之间的患者的腹部 X 光片。我们每个人都使用先前发表的 Barr、Leech 和 Blethyn 评分工具对 X 射线进行独立评估。使用标准统计方法分析分数的可靠性。
Barr 评分的加权κ评分范围为 0.0491 至 0.4809，Leech 评分的范围为 0.1195 至 0.2730，Blethyn 评分的范围为 0.0454 至 0.4514。κ评分的指南是大于 0.75-优秀，0.4 至 0.75-良好，0 至 0.4-可重复性差。另一种可靠性衡量标准 ICC 为 Barr 为 0.02577，Leech 为 0.3313，Blethyn 为 0.201。ICC 解释是大于 0.75-优秀，0.4 至 0.75-良好，0 至 0.4-差。具有经验的泌尿科医师（Barr 和 Blethyn 工具分别为 0.48 和 0.45）之间的评分工具具有良好的组内可靠性趋势，但经验较少的评分者或 Leech 工具之间则没有这种趋势。
目前用于通过 X 射线评估便秘的评分工具在多位检查者中没有良好的可靠性。需要进一步研究开发替代工具，以提高多位检查者之间 X 射线评估便秘的可靠性。
