Beyond the Rome IV criteria: Diagnostic accuracy of clinical tools for functional constipation in children and adolescents

Abstract

Introduction: Functional constipation (FC) is the most prevalent digestive complaint in children and adolescents, significantly impacting quality of life and often associated with fecal incontinence, emotional disturbances, and urinary symptoms. Although its diagnosis is primarily clinical and based on the Rome IV criteria, the lack of objective severity parameters and reliance on self-reported symptoms can hinder early identification. In this context, the present study aimed to evaluate the diagnostic accuracy of commonly used auxiliary tools - the pediatric-adapted Cleveland Clinic Constipation Score (CCS), the Bristol Stool Scale, the Dysfunctional Voiding Symptom Score (DVSS), and rectal diameter (RD) - using the Rome IV criteria as the gold standard.

Methods: This cross-sectional study included 106 patients aged 4-17 years, evaluated in general pediatric and specialized lower urinary tract dysfunction outpatient clinics. Each assessment tool was compared against the Rome IV criteria in terms of sensitivity, specificity, and overall accuracy.

Results: The CCS demonstrated the highest diagnostic accuracy (92.1 %), with a sensitivity of 89.5 % and specificity of 80.0 %, establishing it as an effective tool not only for diagnosing FC but also for grading its severity. Item 4 of the DVSS, which assesses the perception of effort during defecation, showed an accuracy of 72.5 % and should be valued by healthcare professionals as a relevant marker of FC. In contrast, the Bristol Stool Scale (types 1 and 2), RD measurement, and DVSS item 3 (bowel movement frequency) presented low accuracy levels (<60 %).

Conclusion: With its high accuracy, the CCS has proven to be a valid and reliable tool that supports the diagnosis of functional constipation and may also assist in determining its severity. Additionally, DVSS item 4 proves useful in clinical evaluation, while other instruments should be considered auxiliary tools, applied selectively based on individual patient needs.

Keywords: Accuracy; Bristol stool scale; Constipation; Constipation score; Diagnosis; Rectal diameter.