Abstract
Purpose
To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients.
Method
This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess “fecal loading” [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess “renal stones” [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann’s method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients.
Results
Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: − 0.4 [90% CI − 0.7, − 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)].
Conclusion
Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.
Similar content being viewed by others
References
Lacy BE, Levenick JM, Crowell M (2012) Chronic constipation: new diagnostic and treatment approaches. Therapeutic advances in gastroenterology 5 (4):233-247. https://doi.org/10.1177/1756283x12443093
Vazquez Roque M, Bouras EP (2015) Epidemiology and management of chronic constipation in elderly patients. Clinical interventions in aging 10:919-930. https://doi.org/10.2147/cia.s54304
Higgins PD, Johanson JF (2004) Epidemiology of constipation in North America: a systematic review. The American journal of gastroenterology 99 (4):750-759. https://doi.org/10.1111/j.1572-0241.2004.04114.x
Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R (2016) Bowel Disorders. Gastroenterology 150 (6):1393-1407.e1395. https://doi.org/10.1053/j.gastro.2016.02.031
Simren M, Palsson OS, Whitehead WE (2017) Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice. Current gastroenterology reports 19 (4):15-15. https://doi.org/10.1007/s11894-017-0554-0
National Collaborating Centre for Ws, Children’s H (2010) National Institute for Health and Clinical Excellence: Guidance. In: Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care. RCOG Press. National Collaborating Centre for Women’s and Children’s Health., London
Cowlam S, Vinayagam R, Khan U, Marsden S, Minty I, Moncur P, Bain I, Yiannakou YJ (2008) Blinded comparison of faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation. Clinical radiology 63 (12):1326-1331. https://doi.org/10.1016/j.crad.2008.06.011
Reber J, McGauvran A, Froemming A (2018) Abdominal radiograph usage trends in the setting of constipation: a 10-year experience. Abdominal radiology (New York) 43 (9):2231-2238. https://doi.org/10.1007/s00261-018-1466-7
Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, Berger MY (2005) Diagnostic value of abdominal radiography in constipated children: a systematic review. Archives of pediatrics & adolescent medicine 159 (7):671-678. https://doi.org/10.1001/archpedi.159.7.671
Hanauer DA, Mei Q, Law J, Khanna R, Zheng K (2015) Supporting information retrieval from electronic health records. J of Biomedical Informatics 55 (C):290-300. https://doi.org/10.1016/j.jbi.2015.05.003
The Big List of Narcotic Drugs. (2018) American Addiction Centers. https://americanaddictioncenters.org/the-big-list-of-narcotic-drugs/. Accessed October 23 2018
Medical Imaging Resource Community (MIRC). (2018) Radiological Society of North America. http://mirc.rsna.org/query. Accessed 10/23/18 2018
Leech SC, McHugh K, Sullivan PB (1999) Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children. Pediatric radiology 29 (4):255-258. https://doi.org/10.1007/s002470050583
van den Bosch M, Graafmans D, Nievelstein R, Beek E (2006) Systematic assessment of constipation on plain abdominal radiographs in children. Pediatric radiology 36 (3):224-226. https://doi.org/10.1007/s00247-005-0065-2
Rezazadeh A, Javaherizadeh H, Chahardahcherik F, Yavarahmadi MH, Sadjadei N, Tahmasebi M (2016) Reliability of Barr, Leech, and Blethyn score in using of plain radiography in determining fecal impaction in children with and without constipation. Arquivos de gastroenterologia 53 (3):141-145. https://doi.org/10.1590/s0004-28032016000300004
de Lorijn F, van Rijn RR, Heijmans J, Reitsma JB, Voskuijl WP, Henneman OD, Taminiau JA, Benninga MA (2006) The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy. Pediatric radiology 36 (1):43-49. https://doi.org/10.1007/s00247-005-0031-z
Schuirmann DJ (1987) A comparison of the two one-sided tests procedure and the power approach for assessing the equivalence of average bioavailability. Journal of pharmacokinetics and biopharmaceutics 15 (6):657-680
Shankar PR, Kaza RK, Al-Hawary MM, Masch WR, Curci NE, Mendiratta-Lala M, Sakala MD, Johnson TD, Davenport MS (2018) Impact of Clinical History on Maximum PI-RADS Version 2 Score: A Six-Reader 120-Case Sham History Retrospective Evaluation. Radiology 288 (1):158-163. https://doi.org/10.1148/radiol.2018172619
Landers R (2015) Computing Intraclass Correlations (ICC) as Estimates of Interrater Reliability in SPSS. The Winnower . https://doi.org/10.15200/winn.143518.81744
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychological bulletin 86 (2):420-428.
Cicchetti D (1994) Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instrument in Psychology, vol 6. https://doi.org/10.1037/1040-3590.6.4.284
Funding
Unfunded study.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Khan, O., Shankar, P.R., Parikh, A.D. et al. Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects. Abdom Radiol 44, 821–827 (2019). https://doi.org/10.1007/s00261-018-1869-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-018-1869-5