Erik Beek

Systematic assessment of constipation on plain abdominal radiographs in children

Background: Constipation in childhood is common and its clinical assessment is often difficult. Plain abdominal radiography is simple and used to quantify constipation. Three scoring systems, those of Barr et al., Leech et al. and Blethyn et al., have been developed to quantify fecal loading on the abdominal radiograph.Objective: In order to determine which method is the most useful in clinical practice, we assessed the reproducibility of the three scoring systems.Materials and methods: Plain abdominal radiographs from 40 clinically constipated children were retrospectively reviewed by two paediatric radiologists on two separate occasions. The radiographs were scored according to three different systems developed by Barr et al., Leech et al., Blethyn et al. Intraobserver variability and interobserver reproducibility were determined for each system. Kappa coefficients were calculated as indicators of inter- and intraobserver agreement for categorical outcome variables.Results: The Leech score showed the highest reproducibility: the intraobserver agreement was high for both observers (κ values of 0.88 and 1.00, respectively, P<0.05). Furthermore, the interobserver agreement was also high: κ 0.91 in the first round and 0.84 in the second.Conclusions: The Leech score proved to be a highly reproducible tool for assessment of childhood constipation and is of value in clinical practice for systematic assessment of constipation on plain abdominal radiographs in children.

The value of routine chest radiographs in a paediatric intensive care unit: a prospective study.

Background. In many paediatric intensive care units (PICUs) chest X-ray films (CXRs) are required as part of the daily examination or after completion of invasive procedures. Objective. First, to evaluate if the American College of Radiology (ACR) guidelines for adult patients are appropriate for paediatric pa- tients. Second, to assess the diagnostic efficacy of the CXRs. Materials and methods. One-hundred-seventy-four CXRs acquired in 74 patients, either routinely or after invasive procedures, were analysed. The indication of the obtained CXRs, or the absence of indication in patients in whom no CXRs was taken, was compared with ACR guidelines. The position of medical devices was evaluated. Changes in cardiopulmonary status were noted. Results. Sixty-seven percent of the CXRs were in accordance with the ACR guidelines, and in 74 % of pa- tients in whom no CXRs were taken this was also in accordance with these guidelines. Sixteen percent of the endotracheal tubes, 23 % of central venous lines and 15 % of nasogastric tubes were malpositioned. Changes in cardiopulmonary status, after the initial film, were noted in 63 %. Conclusions. The indications for the majority of CXRs in our PICU appeared to be in accordance with ACR guidelines. The high percentage of malpositioned tubes and lines and the number of cardiopulmonary changes on CXRs in a PICU underline the value of these films. Adjustments of the ACR guidelines for particular groups of paediatric patients may limit the number of CXRs taken and may further increase diagnostic efficacy.