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J Korean Soc Emerg Med > Volume 24(2); 2013 > Article
Journal of The Korean Society of Emergency Medicine 2013;24(2): 224-229.
Abdominal Radiography for the Evaluation of Acute Fecal Impaction in Children in Pediatric Emergency Department: Comparison of Three Scoring Methods
Jungho Choi, Young Ho Kwak, Do Kyun Kim, Jin Hee Yi, Jin Hee Jeong, Hahn Bom Kim, Jae Yun Jung, Dong Bum Suh, Jung Eun Cheon, Young Hun Choi
1Department of Emergency Medicine, College of Medicine Seoul National University, Seoul, Korea. birdbeak@snuh.org
2Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
3Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
4Department of Radiology and the Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea.
The aim of this study is to evaluate suitable tools for an approach to acute fecal impaction by comparison of the Leech, Barr and Blethyn scoring methods in pediatric emergency department (PED).
Children with diagnosis of fecal impaction were included in this study at PED of Seoul National University Hospital. Of them, 50 children were randomly selected and their radiographs were independently scored on two occasions at two weeks intervals using three scoring methods by nine emergency physicians and one radiologist. Inter-observer and intra-observer agreement were assessed by calculating intra-class correlation coefficient (ICC). Likert scale was used to assess the easiness and effectiveness of Leech, Barr and Blethyn scoring methods.
(I) Inter-observer agreement: The ICC values of the Leech, Barr and Blethyn were 0.861, 0.887, and 0.821 at first trial and 0.889, 0.891, and 0.827 at second trial, respectively (p<0.001 for all). (II) Intra-observer agreement: Among researchers, the numbers who showed very confident (ICC>0.8) were 5, 6 and 2 in Leech, Barr and Blethyn, respectively. (III) Easiness and effectiveness: The mean Likert scale of the Leech, Barr and Blethyn in easiness was 4.4, 1.4, and 3.9 and in effectiveness, 3.9, 2.9, and 3.2, respectively; it showed significant differences for both attributes (p<0.001, p=0.03, respectively). In post-hoc test, the Leech was assumed to be easier and more effective than Barr (p<0.001). However, no significant differences in easiness and effectiveness were observed between Leech and Blethyn (p=0.37, p=0.14, respectively).
The Leech, Barr and Blethyn have all good inter-observer agreement. The Leech has been found to carry better intra-observer agreement than the other two, and may be one of the easiest and most effective tools for the evaluation of acute fecal impaction in children in PED.
Key words: Fecal Impaction, Abdominal Radiography, Children, Observer Variation
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