Cross-cultural adaptation and validation of the constipation scoring system for the pediatric population: A new tool to be used for constipated children

Abstract

Background: The Rome IV criteria are used to characterize constipation and its subtypes, but not its severity. Conversely, the constipation scoring system (CSS) is a tool designed to assess the level of constipation severity and assist clinicians in selecting suitable therapeutic strategies. Although validated for adults, this score has yet to be validated for children.

Objective: To adapt and validate the CSS for the pediatric population.

Methods: Children and adolescents of 4-17 years of age with no morphological or neurological abnormalities of the gastrointestinal system were randomly selected during general consultation with a pediatrician and evaluated between November 2021 to April 2022. The Rome IV criteria were considered the gold-standard detection method. The adapted version was initially assessed on 30 children to assess comprehension and then administered to another 100 children. The internal consistency of the adapted questionnaire was assessed in a test-retest procedure with a two-week interval.

Results: One hundred patients with a mean age of 8.61 ± 3.25 years were assessed. Of these, 51 (51 %) were male. Most children (n = 91) received a score of 1-10 (the total CSS score can range from 0 to 30 points). The correlation between the pediatric version of the CSS and the Rome IV criteria was substantial, as shown by a positive Spearman correlation (r2) of 0.553 (p < 0.001). Cronbach's alpha between the test-retest responses was 0.97. When each item of the questionnaire was assessed individually, a greater level of internal consistency was found, indicating adequate internal reliability.

Discussion: The current study broadens the horizon with the emergence of new diagnostic aid for FC in Brazilian children and adolescents. In addition, this study provides the cornerstone for future research to determine the diagnostic accuracy of the CSS and its prognostic value for monitoring the treatment. The loss of a follow-up rate (26 %) during the telephone "test-retest" phase was a limitation. Using a subjective questionnaire such as the Rome IV criteria as the gold standard method may also represent a limitation. Further research is required on the use of objective diagnostic tools for FC including colonic transit time, anal manometry, cine-defecography, and electromyography.

Conclusion: The CSS was successfully adapted for use with the pediatric population and was well accepted, confirming its language and psychometric validity in aiding the diagnosis of functional constipation. This was the first step towards validating the use of this score in other countries and cultures to assess the severity of constipation in children.

Keywords: Adolescents; Children; Functional constipation.