From the Division of Pediatric Gastroenterology and Nutrition, Stony.
Division of Pediatric Gastroenterology and Nutrition, Prisma Health, Columbia, SC.
J Pediatr Gastroenterol Nutr. 2023 Mar 1;76(3):295-299. doi: 10.1097/MPG.0000000000003696. Epub 2022 Dec 28.
The current gold standard for the diagnosis of functional constipation is the ROME IV criteria. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) guidelines do not support the use of abdominal X-rays in establishing the diagnosis of constipation. Despite these recommendations, abdominal radiography is frequently performed to diagnose constipation. The objective of our study is to evaluate inter and intraobserver variation in interpretation of fecal loading on abdominal radiographs.
Electronic records of 100 children seen in the emergency room for gastrointestinal symptoms who had an abdominal radiograph performed were included. Four physicians from each specialty including gastroenterology, radiology, and emergency medicine interpreted the radiographs independently. Initially, subjective interpretations, followed by interpretations for intraobserver variation were obtained. Subsequently, all physicians were trained and asked to score the X-rays objectively using Barr and Blethyn scoring systems. Consistency between inter and intraobserver ratings of radiographic interpretation was evaluated using the Kappa coefficient ( k ) which ranges from 0 (no agreement) to 1.0 (perfect agreement).
For subjective interpretations, k values showed a fixed margin k of 0.18 indicating poor agreement among 12 observers. Intraobserver k to look for reproducibility showed significant variability ranging from 0.08 (poor) to 0.61 (fair) agreement. Objective scoring results for Blethyn showed a k of 0.14 indicating poor agreement among 12 providers.
Reliability and reproducibility of X-rays for diagnosis and grading of constipation is questionable given poor to fair agreement for both inter and intraobserver comparisons. Our study supports the current recommendation of ESPGHAN and NASPGHAN to not use abdominal X-rays to diagnose constipation.
功能性便秘的现行金标准诊断方法为罗马 IV 标准。欧洲小儿胃肠病学、肝病和营养学会（ESPGHAN）和北美小儿胃肠病学、肝病和营养学会（NASPGHAN）指南不支持使用腹部 X 光片来确诊便秘。尽管有这些建议，腹部 X 光检查仍常被用于诊断便秘。本研究旨在评估腹部 X 光片上粪便负荷的解读在观察者间和观察者内的差异。
纳入了 100 名因胃肠道症状在急诊就诊并接受腹部 X 光检查的儿童的电子病历。来自胃肠病学、放射学和急诊医学等四个专业的 4 名医生独立对 X 光片进行了解读。首先，进行了主观解读，然后进行了观察者内变异的解读。随后，所有医生都接受了培训，并要求使用 Barr 和 Blethyn 评分系统对 X 光片进行客观评分。观察者间和观察者内的 X 光片解读一致性通过 Kappa 系数（k）进行评估，k 值范围从 0（无一致性）到 1.0（完全一致）。
对于主观解读，k 值显示固定边际 k 为 0.18，表明 12 名观察者之间的一致性较差。观察重复性的内 K 值显示出显著的可变性，范围从 0.08（差）到 0.61（尚可）的一致性。Blethyn 的客观评分结果显示 k 值为 0.14，表明 12 名提供者之间的一致性较差。
鉴于观察者间和观察者内比较的一致性均较差，X 光片在便秘的诊断和分级方面的可靠性和可重复性值得怀疑。本研究支持 ESPGHAN 和 NASPGHAN 目前不建议使用腹部 X 光片来诊断便秘的建议。
