ARQGA 1845.indd

Background Several scoring was developed for evaluation of children with fecal retention using plain radiograph. There are controversies about specificity and sensitivity of these scoring system. Objectives The aim of this study was to evaluate Barr, Blethyn, and Leech score in evaluation of fecal load in plain radiograph. Methods This case control study was conducted on children aged 2-14 years old with abdominal pain who visited Abuzar children’s Hospital of Ahvaz University of Medical Sciences. This study was conducted in fall season. Children with history of previous abdominal surgery, any systemic illness including sickle cell anemia were excluded. Children with constipation were placed in case group. Subjects without constipation were placed in control group. Subjects without exclusion criteria were examined by physician who is blind to aim of the study. Careful history and physical examination was done. Demographic features, history of gastrointestinal problem, duration of abdominal pain, defecation habit, stool consistency (loose, hard), and results of physical examination were recorded. Rome III criteria was used for definition of constipation. Abdominal x-ray was ordered for each patients. Abdominal radiography was reviewed by radiologist. Barr, Leach, and Blethyn scores were calculated for each case. Results In this study 102 children with functional constipation and 102 children without constipation as a control were included. Mean ±SD for case and control group was 68.39±34.88 and 69.46±32.60 (P=0.82). Leech score (mean ±SD) was 11.05±2.177 and 5.67±3.228 for case and control group respectively (P<0.0001). Barr score (mean ±SD) was 14.86±3.54 and 7.16±5.59 for case and control group respectively (P=<0.0001). Blethyn (mean ±SD) score was 1.97±0.667 and 1.04±0.900 for case and control group respectively (P=0.000). Sensitivity and specificity of Barr score was 83% and 79% respectively. Sensitivity and specificity of Leech score was 92% and 80% respectively. Sensitivity and specificity of Blethyn score was 79% and 92% respectively. Conclusion – Barr, Blethyn and Leech scores were significantly higher in children with abdominal pain and constipation in contrast to children with abdominal pain and without constipation. Sensitivity of Leech score was more than Barr and Blethyn scoring systems. Specificity of Blethyn score was more than Barr and Leech score. HEADINGS Constipation. Child health. Abdominal pain. X-ray. Encopresis. Fecal impaction. Declared conflict of interest of all authors: none Disclosure of funding: no funding received Limitation: Post treatment evaluation is lacking. 1 Department of Radiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2 Nursing Care Research Center in Chronic Diseases and Dept. of Pediatric Gastroenterology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 3 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 4 Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran. Correspondence: Farzaneh Chahardahcherik. Student Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 61956, Iran. E-mail: [email protected] In the study by Barr et al. on 30 children with constipation and 12 children without constipation, sensitivity and specificity of radiologic evaluation was 80% and 90% respectively(1). In another study by Leech et al., there was significant difference between scores of children with constipation and without constipation with sensitivity and specificity which was 76% and 75% respectively(13). In a systematic review by Berger et al., they did not find sufficient evidence for role of plain abdominal x-ray in diagnosis of functional constipation in children(4). There was a controversy regarding reliability of three scoring system. Plain abdominal radiograph is a simple method which omit stressful examination, digital rectal examination, for uncooperative child. Rezazadeh A, Javaherizadeh H, Chahardahcherik F, Yavarahmadi MH, Sadjadei N, Tahmasebi M. Reliability of Barr, Leech, and Blethyn score in using of plain radiography in Determining Fecal Impaction in children with and without constipation 142 Arq Gastroenterol v. 53 no. 3 jul./set. 2016 Because these controversies and there was no such study in our country, the current study was carried out to reevaluate these scoring system in diagnosis of stool impaction using Barr, Blethyn, and Leech score.