BACKGROUND: We compared four protocols for assessing fecal continence (FC) in anorectal malformation (ARM). METHODS: Of 111 ARM cases we treated by anoplasty from 1995 to 2007, 59 have been followed up for more than 4 years [male high (n = 23), male low (n = 12), female high (n = 7), and female low (n = 17)] and 27 for more than 7 years [male high (n = 11), male low (n = 5), female high (n = 5), and female low (n = 6)]. FC was assessed in these 86 cases using each of the four protocols; the Kelly score (0-6 points), the Japanese Study Group of Anorectal Anomalies (JSGA) score (0-8 points), the Holschneider score (0-14 points), and our original score (0-10 points). Results were re-classified into four outcome levels (good, fair, poor, very poor) for direct comparison. RESULTS: Outcome was different by two levels (i.e., good vs. very poor) in 7 (8.1%) assessments and different by one category (i.e., fair vs. poor) in ten assessments (11.6%). Outcome was different most often in male high ARM cases and JSGA scores were most divergent. CONCLUSIONS: Fecal continence in male high ARM appears to be assessed inconsistently and a review of protocols may be of value to standardize clinical assessment and enhance reliability.
BACKGROUND: We compared four protocols for assessing fecal continence (FC) in anorectal malformation (ARM). METHODS: Of 111 ARM cases we treated by anoplasty from 1995 to 2007, 59 have been followed up for more than 4 years [male high (n = 23), male low (n = 12), female high (n = 7), and female low (n = 17)] and 27 for more than 7 years [male high (n = 11), male low (n = 5), female high (n = 5), and female low (n = 6)]. FC was assessed in these 86 cases using each of the four protocols; the Kelly score (0-6 points), the Japanese Study Group of Anorectal Anomalies (JSGA) score (0-8 points), the Holschneider score (0-14 points), and our original score (0-10 points). Results were re-classified into four outcome levels (good, fair, poor, very poor) for direct comparison. RESULTS: Outcome was different by two levels (i.e., good vs. very poor) in 7 (8.1%) assessments and different by one category (i.e., fair vs. poor) in ten assessments (11.6%). Outcome was different most often in male high ARM cases and JSGA scores were most divergent. CONCLUSIONS: Fecal continence in male high ARM appears to be assessed inconsistently and a review of protocols may be of value to standardize clinical assessment and enhance reliability.
Authors: Alexander Holschneider; John Hutson; Albert Peña; Elhamy Beket; Subir Chatterjee; Arnold Coran; Michael Davies; Keith Georgeson; Jay Grosfeld; Devendra Gupta; Naomi Iwai; Dieter Kluth; Giuseppe Martucciello; Samuel Moore; Risto Rintala; E Durham Smith; D V Sripathi; Douglas Stephens; Sudipta Sen; Benno Ure; Sabine Grasshoff; Thomas Boemers; Feilin Murphy; Yunus Söylet; Martin Dübbers; Marc Kunst Journal: J Pediatr Surg Date: 2005-10 Impact factor: 2.545