比较常见的肛门直肠畸形患者排便功能评分系统的一致性和可用性。

Comparing Consistency and Usability of Common Bowel Function Scoring Systems in Anorectal Malformation Patients.

机构信息

Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; Division of Paediatric Surgery, Department of Surgery, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

出版信息

J Pediatr Surg. 2024 Apr;59(4):571-576. doi: 10.1016/j.jpedsurg.2023.12.002. Epub 2023 Dec 7.

DOI:10.1016/j.jpedsurg.2023.12.002

PMID:38160189

Abstract

BACKGROUND

Assessment of postoperative bowel function in anorectal malformation (ARM) patients is crucial for benchmarking outcomes. We compared existing bowel function scoring systems in various aspects in patients with ARM.

METHODS

With ethical approval, this was a cross-sectional study involving 5 paediatric surgery referral centres in Malaysia, comparing the Kelly, Japanese Study Group of Anorectal Anomalies (JSGA), Holschneider and Krickenbeck bowel function questionnaires. We recruited patients aged 4-17 years, who had completed definitive surgery & stoma closure (where relevant) > 12 months prior to participation. We standardised outcomes of each scoring system into categories ('good', 'fair', 'poor' and 'very poor') to facilitate comparison. Parents & patients were surveyed and asked to rate the ease of understanding of each questionnaire. The difference in protocol scores rated between parents and patients were compared. Association of each bowel function scoring protocol with type of anomaly was assessed. Statistical significance was p < 0.05.

RESULTS

Thirty-nine parents (21 mothers, 18 fathers) and 23 patients were included in this study. Fair agreement was found between Kelly and Krickenbeck protocols (κ = 0.343; p < 0.001), between JSGA constipation and Holschneider protocols (κ = 0.276; p = 0.002); JSGA constipation and Krickenbeck protocols (κ = 0.256; p = 0.004); and between Holschneider and Krickenbeck protocols (κ = 0.273; p = 0.003). Only the Kelly protocol showed significant correlation between parents and patients' answers (ρ = 0.459, p = 0.028). Krickenbeck demonstrated the best negative correlation of patients' scores with ARM types (ρ = -0.401, p = 0.001). The Kelly protocol ranked highest when comparing ease of understanding.

CONCLUSION

All the questionnaires appeared comparable in assessing postoperative faecal continence in ARM patients. The Kelly questionnaire performed best in 3 key areas of assessment.

LEVEL OF EVIDENCE

Level III Cross-Sectional Study.

摘要

背景

评估肛门直肠畸形（ARM）患者的术后肠功能对于评估结果至关重要。我们比较了各种 ARM 患者的现有肠功能评分系统。

方法

本研究为经过伦理批准的横断面研究，纳入了马来西亚 5 家儿科手术转诊中心，比较了 Kelly、日本肛肠畸形研究组（JSGA）、Holschneider 和 Krickenbeck 肠功能问卷。我们招募了在参与研究前已完成确定性手术和造口关闭（如适用）>12 个月的 4-17 岁患者。我们将每个评分系统的结果标准化为类别（“良好”、“一般”、“差”和“很差”），以便于比较。我们调查了父母和患者，并要求他们对每个问卷的理解难易程度进行评分。比较了父母和患者对协议评分的差异。评估了每种肠功能评分方案与畸形类型的相关性。具有统计学意义的 p 值<0.05。

结果

本研究纳入了 39 位家长（21 位母亲，18 位父亲）和 23 位患者。Kelly 和 Krickenbeck 方案之间存在良好的一致性（κ=0.343；p<0.001），JSGA 便秘和 Holschneider 方案之间存在良好的一致性（κ=0.276；p=0.002）；JSGA 便秘和 Krickenbeck 方案之间存在良好的一致性（κ=0.256；p=0.004）；Holschneider 和 Krickenbeck 方案之间存在良好的一致性（κ=0.273；p=0.003）。只有 Kelly 方案显示出父母和患者答案之间存在显著相关性（ρ=0.459，p=0.028）。Krickenbeck 方案显示患者评分与 ARM 类型之间具有最佳的负相关性（ρ=-0.401，p=0.001）。在比较理解难易程度时，Kelly 问卷得分最高。