Comparing Consistency and Usability of Common Bowel Function Scoring Systems in Anorectal Malformation Patients

• Published in: Journal of pediatric surgery Vol. 59; no. 4; pp. 571 - 576
• Main Authors: Shaari, Mohd Khairulanuar, Tan, Yew-Wei, Abdullah, Mohd Yusof, Sharudin, Mohd Fauzi, Osman, Marjmin, Teoh, Tammy Han Qi, Lim, Chien Joo, Nah, Shireen Anne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2024
• Subjects: Anorectal malformation; Bowel function scoring; Constipation; Faecal incontinence; Outcomes; Faecal incontinence; Bowel function scoring; Constipation; Outcomes; Anorectal malformation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2023.12.002

Assessment of postoperative bowel function in anorectal malformation (ARM) patients is crucial for benchmarking outcomes. We compared existing bowel function scoring systems in various aspects in patients with ARM. With ethical approval, this was a cross-sectional study involving 5 paediatric surgery referral centres in Malaysia, comparing the Kelly, Japanese Study Group of Anorectal Anomalies (JSGA), Holschneider and Krickenbeck bowel function questionnaires. We recruited patients aged 4–17 years, who had completed definitive surgery & stoma closure (where relevant) > 12 months prior to participation. We standardised outcomes of each scoring system into categories (‘good’, ‘fair’, ‘poor’ and ‘very poor’) to facilitate comparison. Parents & patients were surveyed and asked to rate the ease of understanding of each questionnaire. The difference in protocol scores rated between parents and patients were compared. Association of each bowel function scoring protocol with type of anomaly was assessed. Statistical significance was p < 0.05. Thirty-nine parents (21 mothers, 18 fathers) and 23 patients were included in this study. Fair agreement was found between Kelly and Krickenbeck protocols (κ = 0.343; p < 0.001), between JSGA constipation and Holschneider protocols (κ = 0.276; p = 0.002); JSGA constipation and Krickenbeck protocols (κ = 0.256; p = 0.004); and between Holschneider and Krickenbeck protocols (κ = 0.273; p = 0.003). Only the Kelly protocol showed significant correlation between parents and patients' answers (ρ = 0.459, p = 0.028). Krickenbeck demonstrated the best negative correlation of patients’ scores with ARM types (ρ = −0.401, p = 0.001). The Kelly protocol ranked highest when comparing ease of understanding. All the questionnaires appeared comparable in assessing postoperative faecal continence in ARM patients. The Kelly questionnaire performed best in 3 key areas of assessment. Level III Cross-Sectional Study. What is currently known about this topic? While there are many scoring systems to assess bowel function, there is not much information in regard to differences in applicability of the systems, whether they are easy to understand, are reflective of the types of ARM, and can be adapted to the local setting.What new information is contained in this article? The Kelly questionnaire performed best overall in 3 key areas of assessment: parent-patient inter-rater correlation, association between type of anomaly and bowel function, and ease of use.