title: Developing a new electromyography-based algorithm to diagnose the etiology of fecal incontinence.
abstract: OBJECTIVE
  For surface electromyography (sEMG) to become widely used in fecal incontinence (FI) etiology assessment, one would have to create a simple, step-by-step, computer-aided, electromyography-based algorithm that would become the basis for a computer-aided diagnosis (CAD) system. Thus, the aim of this work was to develop such an algorithm.
  
  
  METHODS
  Each patient included in the study underwent a structured medical interview, a general physical examination, and a proctological examination. Patients that scored more than 10 points on the fecal incontinence severity index (FISI) underwent further tests that included rectoscopy, anorectal manometry, transanal ultrasonography, multichannel sEMG, and assessment of anal reflexes. Patients with fully diagnosed FI were included into the study group. The control group consisted of healthy volunteers that scored five or less points on the FISI and had no known anal sphincters dysfunction.
  
  
  RESULTS
  Forty-nine patients were qualified to the study group (age ± SD 58.9 ± 13.8). The control group was number- and gender-matched (age ± SD 45.4 ± 15.1). The sensitivity and specificity of classification tree number I, to diagnose neurogenic FI, were 89.5 and 86 %, respectively. For patients with idiopathic FI, these values were 82 and 91 %, respectively. The sensitivity and specificity of classification tree number III, to diagnose neurogenic FI, were 84 and 78 %, respectively. For patients with idiopathic FI, these values were 78 and 87 %, respectively.
  
  
  CONCLUSIONS
  The relative simplicity and low classification costs allow to assume that algorithms based on classification trees I and III will serve to be the basis for a FI etiology CAD system.
authors.affiliation: Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Nowakowski
authors.forename: Krzysztof A
authors.initials: KA
authors.lastname: Tomaszewski
authors.forename: Roman M
authors.initials: RM
authors.lastname: Herman
authors.forename: Jerzy
authors.initials: J
authors.lastname: Sałówka
authors.forename: Michał
authors.initials: M
authors.lastname: Romaniszyn
authors.forename: Mateusz
authors.initials: M
authors.lastname: Rubinkiewicz
authors.forename: Jerzy A
authors.initials: JA
authors.lastname: Walocha
mesh_terms: D000328:Adult; D000465:Algorithms; D001003:Anal Canal / Q000503:physiopathology; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D005242:Fecal Incontinence / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
references.citation: ANZ J Surg. 2004 Aug;74(8):671-5
references.pmid: 15315569
references.citation: Endoscopy. 2010 Mar;42(3):203-7
references.pmid: 20101564
references.citation: Neurourol Urodyn. 2010 Mar;29(3):449-57
references.pmid: 19634169
references.citation: Br J Surg. 2002 Oct;89(10):1268-9
references.pmid: 12296894
references.citation: Digestion. 2004;69(2):123-30
references.pmid: 15087579
references.citation: J Am Geriatr Soc. 2010 Jul;58(7):1341-6
references.pmid: 20533967
references.citation: Br J Surg. 2007 Feb;94(2):134-44
references.pmid: 17221850
references.citation: J Neurogastroenterol Motil. 2012 Jan;18(1):86-93
references.pmid: 22323992
references.citation: Digestion. 2004;69(2):102-11
references.pmid: 15087577
references.citation: Dis Colon Rectum. 1999 Dec;42(12):1525-32
references.pmid: 10613469
references.citation: Dis Colon Rectum. 2004 Aug;47(8):1341-9
references.pmid: 15484348
references.citation: Gastroenterol Res Pract. 2012;2012:947694
references.pmid: 21960998
references.citation: Comput Med Imaging Graph. 2012 Oct;36(7):527-41
references.pmid: 22575846
references.citation: Neurogastroenterol Motil. 2005 Jun;17 Suppl 1:60-7
references.pmid: 15836456
references.citation: Neurogastroenterol Motil. 2002 Oct;14(5):553-9
references.pmid: 12358684
references.citation: Am J Gastroenterol. 2010 Feb;105(2):412-9
references.pmid: 19844202
references.citation: J Electromyogr Kinesiol. 2011 Apr;21(2):394-401
references.pmid: 21130667
references.citation: Can J Gastroenterol. 2009 Apr;23(4):301-8
references.pmid: 19373424
references.citation: Dis Colon Rectum. 2004 Feb;47(2):192-6; discussion 196-7
references.pmid: 15043289