Originally sent by Rasha



I've always questioned doing X-rays for diagnosing (or even aiding in the diagnosis of) constipation in children as it is mostly a clinical diagnosis, plus I find the interpretation of the films very subjective.  Yet, a recent ED study showed that 70% of children with the final diagnosis of constipation get abdominal X-rays in the ED. (1)

I've been searching the literature all afternoon to determine the value of abdominal films in the diagnosis of constipation and the answers seem all over the place.

I also discovered that there are scoring systems to read these abdominal films. No one had ever taught me that! There are mainly 3 that I found in the literature. (2) However these scoring systems have mixed results about their intra and inter-observer reliability and diagnostic validity. The Leech system seems to be "the best" - to be taken with a grain of salt.
So after going around in circles I am left with these 2 articles. You're more than welcome to read just one. They seem to be the most recent and up to date.

The 1st is a systematic review. It is an update from one in 2005 (3), which still reports inconsistent evidence for a diagnostic association between clinical symptoms of constipation and fecal loading on abdominal radiographs.

The 2nd (full text not included here due to technical difficulties) is a recent look at the 3 scoring systems. It's interesting to read if you haven't heard about them before, especially the Leech one, which seems to have positive results in several previous small studies too. (2)

Will this change what I do? 
I think that I will still try to minimize as much as possible ordering X-rays to confirm a diagnosis of constipation, however if I do have an X-ray, I will try to use more objective measures such as the Leech scoring system to interpret the films, and maybe start taking into account other scoring methods such as the Bristol Stool form scale.

References

1- Miller et al. Emergency Department Management and Short-Term Outcome of Children With Constipation. Pediatric Emergency Care. Vol 23(1), Jan 2007, pp 1-4
2- Maurice et al. Systematic assessment of constipation on plain abdominal radiographs in children. Pediatr Radiol (2006) 36: 224-226
3- Lieke et al. Diagnostic Value of Abdominal Radiography in Constipated Children. A Systematic Review. Arch Pediatr Adolesc Med. 2005;159:671-678