Almkvist Louise, Gunnarsson Ulf, Strigård Karin
Department of Diagnostics and Intervention, Surgery, Umeå University, SE-901 87, Umeå, Sweden.
Updates Surg. 2024 Dec;76(8):2805-2811. doi: 10.1007/s13304-024-01975-4. Epub 2024 Sep 6.
The aim of this study was to investigate if Low Anterior Resection Syndrome (LARS) score contributed with complementary information to Wexner score when assessing fecal incontinence (FI). The hypothesis was that LARS score would be likely to provide complementary information to Wexner score in the assessment of FI regardless of etiology. LARS score has been used as a complement to traditional scoring systems to assess bowel dysfunction, targeting FI among patients after radical cystectomy, in women with endometriosis, and in colorectal cancer patients. Wexner score as a single tool does not address the complexity of FI and urgency, a disabling symptom. A retrospective cohort study at a surgical outpatient clinic included patients diagnosed with FI who answered LARS and Wexner scores questionnaires at their first visit to the clinic between 1st January 2015 and 31st December 2018. Kendall's tau, Spearman rank correlation, Cohen's kappa, and scatterplots were analyzed for participants and specific subgroups to assess any correlation and agreement between answers to the two scoring systems. One hundred nineteen patients met the inclusion criteria, one hundred eight women and eleven men. Kendall's tau ranged from 0.32 to 0.39, indicating lack of correlation. Correlation coefficients using Spearman rank ranged from 0.36 to 0.55, i.e., only fair to moderate correlation. Kappa was 0.21-0.28, i.e., only slight to fair agreement. Distribution of LARS and Wexner scores in the scatterplot showed wide variability and lack of agreement. Combined use of both the Wexner and LARS scores provided complimentary information, and thus a more complete mapping of FI as well as taking all entities in consideration.
本研究的目的是调查在评估大便失禁(FI)时,低位前切除综合征(LARS)评分是否能为韦克斯纳评分提供补充信息。假设是,无论病因如何,LARS评分在评估FI时可能会为韦克斯纳评分提供补充信息。LARS评分已被用作传统评分系统的补充,以评估肠道功能障碍,目标人群包括根治性膀胱切除术后的患者、子宫内膜异位症女性患者以及结直肠癌患者。韦克斯纳评分作为单一工具无法解决FI和急迫性这一致残症状的复杂性。在一家外科门诊进行的一项回顾性队列研究纳入了被诊断为FI的患者,这些患者在2015年1月1日至2018年12月31日首次就诊时回答了LARS和韦克斯纳评分问卷。对参与者和特定亚组分析了肯德尔tau系数、斯皮尔曼等级相关性、科恩kappa系数和散点图,以评估两个评分系统答案之间的任何相关性和一致性。119名患者符合纳入标准,其中108名女性和11名男性。肯德尔tau系数范围为0.32至0.39,表明缺乏相关性。使用斯皮尔曼等级的相关系数范围为0.36至0.55,即仅为中等偏下的相关性。kappa系数为0.21 - 0.28,即仅为轻微至中等的一致性。散点图中LARS和韦克斯纳评分的分布显示出很大的变异性且缺乏一致性。同时使用韦克斯纳评分和LARS评分可提供补充信息,从而更全面地描绘FI情况,并考虑到所有因素。