Diagnosing functional abdominal pain with the Rome II criteria: parent, child, and clinician agreement.
OBJECTIVE
To compare the Rome II diagnoses made in children with recurrent abdominal pain by physicians and by parent and child responses on the Questionnaire on Pediatric Gastrointestinal Symptoms. Rates of diagnostic agreement and reasons for disagreement were examined to determine whether changes to the Rome II criteria are needed to improve diagnostic classification.


METHODS
One hundred and forty-eight children and their parents or guardians completed the Questionnaire on Pediatric Gastrointestinal Symptoms during their first visit to a pediatric gastroenterology clinic. Parent- and child-report Rome II diagnoses were based on Questionnaire on Pediatric Gastrointestinal Symptoms scoring criteria, whereas the physician's Rome II diagnosis was based on clinical impression from history and physical examination completed at this visit. Statistical comparisons involved Pearson chi tests and Fisher exact tests. Kappa and weighted kappa measured agreement rates.


RESULTS
Most children met the criteria for a functional gastrointestinal disorder based on the Rome II criteria. Functional dyspepsia was the most common diagnosis made by all three sources. The percentage of children classified as "no diagnosis" was small and was often a function of symptom duration (especially when diagnosis rested on the child self-report). Diagnostic agreement was fair to moderate. Diagnoses based on parent and child questionnaires agreed more often on functional dyspepsia than irritable bowel syndrome. Diagnostic disagreement was most likely to result from parent and child disagreement on defecation symptoms.


CONCLUSIONS
The Rome II classification system shows promise for improving diagnosis, study and treatment of children with recurrent abdominal pain. However, further refinement and clarification of the Rome II criteria for symptom duration and frequency may be needed to improve diagnostic agreement.
Schurman
Jennifer Verrill
JV
Sections of Developmental Behavioral Sciences, the Children's Mercy Hospital, Kansas City, Missouri 64103, USA. jschurman@cmh.edu
Friesen
Craig A
CA
Danda
Caroline Elder
CE
Andre
Linda
L
Welchert
Elly
E
Lavenbarg
Teri
T
Cocjin
Jose T
JT
Hyman
Paul E
PE
D015746:Abdominal Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D000293:Adolescent; D002648:Child; D003937:Diagnosis, Differential; D004415:Dyspepsia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D015995:Prevalence; D012008:Recurrence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires / Q000592:standards*