Starreveld scoring method in diagnosing childhood constipation.
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.
Kokke
Fredericus T
FT
Pediatric Gastroenterology, Wilhelmina Childrens Hospital, KE 1.144.3, PO Box 85090, Utrecht 3508 AB, The Netherlands, f.t.m.kokke@umcutrecht.nl
Sittig
Judith S
JS
de Bruijn
Annemiek
A
Wiersma
Tjeerd
T
Van Rijn
Rick R
RR
Limpen
Jan L
JL
Houwen
Roderick H
RH
Fischer
Kathelijn
K
Benninga
Marc A
MA
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