title: Starreveld scoring method in diagnosing childhood constipation.
abstract: BACKGROUND
  Four scoring methods exist to assess severity of fecal loading on plain abdominal radiographs in constipated patients (Barr-, Starreveld-, Blethyn- and Leech). So far, the Starreveld score was used only in adult patients.
  
  
  OBJECTIVE
  To determine accuracy and intra- and inter-observer agreement of the Starreveld scoring method in the diagnosis of functional constipation among pediatric patients. In addition, we compared the Starreveld with the Barr scoring method.
  
  
  METHODS
  Thirty-four constipated and 34 non-constipated children were included. Abdominal radiographs, obtained before treatment, were rated (Starreveld- and Barr) by 4 observers. A second observation after 4 weeks was done by 3 observers. Cut-off level for the Starreveld score, accuracy as measured by the area under the receiver operator characteristics curve, and inter- and intra-observer agreement were calculated.
  
  
  RESULTS
  Cut-off value for the Starreveld score was 10. AUC for Starreveld score was 0.54 and for Barr score 0.38, indicating poor discriminating power. Inter-observer agreement was 0.49-0.52 4 (Starreveld) and 0.44 (Barr), which is considered moderate. Intra-observer agreement was 0.52-0.71 (Starreveld) and 0.62- 0.76 (Barr).
  
  
  CONCLUSIONS
  The Starreveld scoring method to assess fecal loading on a plain abdominal radiograph is of limited value in the diagnosis of childhood constipation.
authors.affiliation: Pediatric Gastroenterology, Wilhelmina Childrens Hospital, KE 1.144.3, PO Box 85090, Utrecht 3508 AB, The Netherlands, f.t.m.kokke@umcutrecht.nl
authors.forename: Fredericus T
authors.initials: FT
authors.lastname: Kokke
authors.forename: Judith S
authors.initials: JS
authors.lastname: Sittig
authors.forename: Annemiek
authors.initials: A
authors.lastname: de Bruijn
authors.forename: Tjeerd
authors.initials: T
authors.lastname: Wiersma
authors.forename: Rick R
authors.initials: RR
authors.lastname: Van Rijn
authors.forename: Jan L
authors.initials: JL
authors.lastname: Limpen
authors.forename: Roderick H
authors.initials: RH
authors.lastname: Houwen
authors.forename: Kathelijn
authors.initials: K
authors.lastname: Fischer
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
mesh_terms: D000465:Algorithms; D002648:Child; D003248:Constipation / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011860:Radiography, Abdominal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity