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Abdom Radiol (NY). 2019 Mar;44(3):821-827. doi: 10.1007/s00261-018-1869-5.

Radiographic stool quantification: an equivalence study of 484 symptomatic and asymptomatic subjects.

Author information

1
Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
2
Michigan Radiology Quality Collaborative, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
3
Department of Radiology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. pshankar@med.umich.edu.
4
Michigan Radiology Quality Collaborative, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA. pshankar@med.umich.edu.
5
Department of Radiology, University Hospital, University of Michigan, 1500 E. Medical Center Drive, B1 D530H, Ann Arbor, MI, 48109, USA. pshankar@med.umich.edu.
6
University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
7
Michigan Institute for Clinical and Health Research (MICHR), University of Michigan, 1600 Huron Parkway, Building 400, Ann Arbor, MI, 48105, USA.
8
Department of Gastroenterology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.
9
Department of Urology, Michigan Medicine, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA.

Abstract

PURPOSE:

To determine if symptomatic patients referred for radiographic stool quantification have equivalent stool burden to asymptomatic patients.

METHOD:

This was an IRB-approved HIPAA-compliant retrospective equivalence cohort study. An a priori equivalence power calculation was performed. Consecutive abdominal radiographs performed in adult outpatients with bloating, constipation, diarrhea, or abdominal pain to assess "fecal loading" [n = 242 (fecal cohort)] were compared to those performed in asymptomatic adult outpatients to assess "renal stones" [n = 242 (renal cohort)]. Radiographs were randomized and reviewed by two blinded independent abdominal radiologists. Exclusion criteria, designed to avoid unblinding, included urinary tract calculi ≥ 0.5 cm, multiple urinary tract calculi, and ureteral stent(s). Readers scored all radiographs (n = 484) for stool burden using validated Leech criteria [scale: 0 (none) to 15 (extreme diffuse)]. Mean Leech scores and 95% confidence intervals were calculated. Multivariable generalized linear modeling was performed to adjust for baseline medication use, age, and gender. The adjusted parameter estimate was used to test for equivalence in the mean difference between cohorts using Schuirmann's method of two one-sided t-tests. Inter-reader agreement was assessed with intraclass correlation coefficients.

RESULTS:

Overall mean Leech scores for fecal [6.9 (95% CI 6.7, 7.2)] and renal [7.3 (95% CI 7.1, 7.5)] cohorts were equivalent within a margin of 0.75 (adjusted mean difference: - 0.4 [90% CI - 0.7, - 0.04]; p value = 0.02). Inter-reader agreement was good [ICC: 0.62 (95% CI 0.56, 0.68)].

CONCLUSION:

Radiographic stool quantification produces equivalent results in symptomatic and asymptomatic adults and is of uncertain value.

KEYWORDS:

Abdominal radiograph; Constipation; Fecal loading; Utilization; Value

PMID:
30552438
DOI:
10.1007/s00261-018-1869-5

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