Accuracy of transabdominal ultrasound to diagnose functional constipation and fecal impaction in children: a systematic review and meta-analysis.

IF 2.1 3区医学 Q2 PEDIATRICS Pediatric Radiology Pub Date : 2024-11-15 DOI:10.1007/s00247-024-06083-4

Johanna M B W Vos, Michelle N Bloem, Anna de Geus, Mariska M G Leeflang, René Spijker, Ilan J N Koppen, Desiree F Baaleman, Marc A Benninga

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Abstract

Background: Functional constipation is common in children and accurate diagnostic methods are essential for early diagnosis and effective management. The diagnostic accuracy of transabdominal ultrasound to diagnose functional constipation is unclear.

Objective: To evaluate the diagnostic accuracy of transverse rectal diameter measurement via transabdominal ultrasound in diagnosing children with functional constipation and in identifying fecal impaction.

Materials and methods: Electronic databases were searched from inception to March 2023. Original studies investigating the diagnostic accuracy of measuring transverse rectal diameter via transabdominal ultrasound, including children with and without functional constipation, or with and without fecal impaction were included. Data extraction and quality assessment were performed independently by two reviewers.

Results: Sixteen studies were included (n = 1,801 children, 0-17 years). Thirteen studies investigated the diagnostic accuracy for functional constipation, and five for fecal impaction. High risk of bias was found across the majority of studies mainly due to un-blinded case-control designs. Cut-off transverse rectal diameter values to diagnose functional constipation ranged from 2.4 cm to 3.8 cm. Meta-analysis (seven studies, n = 509 children) estimated mean sensitivity and specificity to diagnose functional constipation were 0.68 (95% confidence interval (CI) 0.55-0.78) and 0.81 (95% CI 0.71-0.88), respectively. Meta-analysis of diagnostic accuracy of identifying fecal impaction was not feasible. Studies reported a sensitivity and specificity ranging between 68-100% and 83-100%, respectively.

Conclusion: Transabdominal ultrasound may be a valuable non-invasive diagnostic tool to diagnose functional constipation by measuring transverse rectal diameter and identifying fecal impaction in children. Heterogeneous study methods and lack of age-dependent normal values impair current clinical recommendations. Future research should focus on separating age groups and developing a standardized protocol.

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经腹超声诊断儿童功能性便秘和粪便嵌塞的准确性：系统回顾和荟萃分析。

背景：功能性便秘在儿童中很常见，准确的诊断方法对于早期诊断和有效治疗至关重要。经腹超声诊断功能性便秘的准确性尚不明确：评估经腹超声测量直肠横径在诊断功能性便秘患儿和鉴别粪便嵌塞方面的诊断准确性：检索了从开始到 2023 年 3 月的电子数据库。纳入了调查通过经腹超声测量直肠横径诊断准确性的原始研究，包括功能性便秘儿童和非功能性便秘儿童，或粪便嵌塞儿童和非粪便嵌塞儿童。数据提取和质量评估由两名审稿人独立完成：结果：共纳入 16 项研究（n = 1,801 名 0-17 岁儿童）。其中 13 项研究调查了功能性便秘的诊断准确性，5 项研究调查了粪便嵌塞的诊断准确性。发现大多数研究存在高偏倚风险，主要原因是采用了非盲法病例对照设计。诊断功能性便秘的直肠横径临界值从 2.4 厘米到 3.8 厘米不等。据 Meta 分析（7 项研究，n = 509 名儿童）估计，诊断功能性便秘的平均灵敏度和特异度分别为 0.68（95% 置信区间 (CI) 0.55-0.78）和 0.81（95% CI 0.71-0.88）。对粪便嵌塞的诊断准确性进行元分析并不可行。研究报告的敏感性和特异性分别为 68-100% 和 83-100%：结论：通过测量直肠横径和识别儿童粪便嵌塞，经腹超声可能是诊断功能性便秘的一种有价值的无创诊断工具。不同的研究方法和缺乏与年龄相关的正常值影响了目前的临床建议。未来的研究应侧重于区分年龄组和制定标准化方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Radiology 医学-核医学

CiteScore

4.40

自引率

17.40%

发文量

300

审稿时长

3-6 weeks

期刊介绍： Official Journal of the European Society of Pediatric Radiology, the Society for Pediatric Radiology and the Asian and Oceanic Society for Pediatric Radiology Pediatric Radiology informs its readers of new findings and progress in all areas of pediatric imaging and in related fields. This is achieved by a blend of original papers, complemented by reviews that set out the present state of knowledge in a particular area of the specialty or summarize specific topics in which discussion has led to clear conclusions. Advances in technology, methodology, apparatus and auxiliary equipment are presented, and modifications of standard techniques are described. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.