A284 DIAGNOSTIC ACCURACY OF THE ABDOMINAL X-RAY IN CHILDHOOD CONSTIPATION: A SYSTEMATIC REVIEW OF THE LITERATURE
Bibliographic record
Abstract
Abstract Background Childhood constipation is a relatively common condition in pediatrics, with a global pooled prevalence of 9.5%. The most common form of constipation in children is functional in nature, a clinical diagnosis defined by the Rome IV criteria. Although available data discourage the use of the abdominal x-ray (AXR) for the evaluation of constipation in children due to its limited value, radiation exposure, as well as its possible misleading nature, a significant number of clinicians continue to use AXRs in children with constipation. Given that it has been 10 years since the last systematic review on this topic was published, an updated systematic review is now warranted. Purpose To evaluate the diagnostic accuracy of the abdominal x-ray in children with functional constipation (FC). Method The protocol was registered (PROSPERO ID: CRD42022301833) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligibility criteria Study population included children and adolescents aged 2 to 18 years with a clinical diagnosis of FC in whom AXR was performed. The radiographic parameters that were used to evaluate the AXR had to be specified by the authors. Exclusion criteria included children with organic causes of constipation and children younger than two years. Information sources, search strategy and selection criteria A reference librarian searched the Medline, Embase and Scopus databases from 2012 (year of last systematic review) to May 2022. The search was limited to English only. In addition, reference lists from selected papers were screened for relevant articles. Data collection Two authors independently screened eligible articles. Disagreements between investigators were resolved by consensus with a third investigator. Extracted data was inputted into a structured collection sheet by two authors working independently. Risk of bias assessment and applicability concerns To assess the risk of bias and applicability concerns, two investigators working independently applied six of the QUADAS-2 items to each of the included articles. Result(s) The search identified a total of 1,125 articles, of which only three were included in the final qualitative analysis. A quantitative analysis was not conducted due to clinical and methodologic heterogeneity. Two studies were conducted in the USA (case-control studies) and one study was conducted in Iran (cohort study), involving a total of 416 children. All three studies used different radiographic parameters to define constipation. The two case-control studies were deemed unclear-to-low risk of bias, while the cohort study was considered unclear-to-high risk of bias. Figure 1 shows the study findings. Image Conclusion(s) There is insufficient evidence to support the use of AXR for the diagnostic workup of FC. More methodologically rigorous studies are needed in order to determine the utility of the AXR in FC. The diagnosis of FC should be based on history and clinical findings. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared OBESITY, METABOLIM & NUTRITION
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.059 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.010 |
| Bibliometrics | 0.011 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".