Development of a Bowel Management Scoring Tool in Pediatric Patients with Constipation

Objective To develop a reliable and valid scoring tool, the Pediatric Bowel Management Scoring Tool (PBMST), to better guide management of constipation in pediatric patients. Study design The project comprised 2 stages, development of the questionnaire and construction of the bowel management score. Two questionnaires were created, one for children aged 8-18 years to self-report and one parent proxy-report for children aged 4-8 years. Questions regarding physical symptoms (n = 6), emotional aspects (n = 2), social activities/school (n = 1), and treatment (n = 1) were included. Patients (or parents of patients) with symptoms of constipation completed the questionnaire. The reproducibility of each question was computed using the Cohen weighted kappa coefficient (kappa). A bowel management score was developed using logistic regression analysis, assessing the associations between the questions and impact on self-reported quality of life (QoL). Questions with adequate reproducibility and significantly associated with QoL were incorporated into the score. Results The questionnaire was completed by 385 patients. Six questions met the inclusion criteria and were incorporated into the score: stool shape (range, 0-3 points), anorectal pain (0-4 points), abdominal pain (0-3 points), frequency of fecal incontinence (0-3 points), assistance of caregivers (0-3 points), and interference with social activities (0-6 points). Differences in bowel management scores among patients reporting no, little, some, or major impact on QoL were statistically significant (P < .001). Conclusions The newly developed and validated PBMST is a reliable tool for evaluating bowel management strategies in children with constipation.

Automated summary

The objective of this study was to develop a reliable and valid scoring tool, the Pediatric Bowel Management Scoring Tool (PBMST), for the management of constipation in pediatric patients. Two questionnaires were created to assess physical symptoms, emotional aspects, social activities/school, and treatment. Logistic regression analysis was used to develop a bowel management score based on the associations with patients' self-reported quality of life. The newly developed PBMST includes six questions and is a reliable tool for evaluating bowel management strategies in children with constipation.