Starreveld scoring method in diagnosing childhood constipation

Fredericus T. Kokke, Judith S. Sittig, Annemiek De Bruijn, Tjeerd Wiersma, Rick R. Van Rijn, Jan L. Limpen, Roderick H. Houwen, Kathelijn Fischer, Marc A. Benninga

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7 Citations (Scopus)


Background Four scoring methods exist to assess severity of fecal loading on plain abdominal radiographs in constipated patients (Barr-, Starreveld-, Blethyn- and Leech). So far, the Starreveld score was used only in adult patients. Objective To determine accuracy and intra- and inter-observer agreement of the Starreveld scoringmethod in the diagnosis of functional constipation among pediatric patients. In addition, we compared the Starreveld with the Barr scoring method. Materials and methods Thirty-four constipated and 34 non-constipated children were included. Abdominal radiographs, obtained before treatment, were rated (Starreveld- and Barr) by 4 observers. A second observation after 4 weeks was done by 3 observers. Cut-off level for the Starreveld score, accuracy as measured by the area under the receiver operator characteristics curve, and inter- and intra-observer agreement were calculated. Results Cut-off value for the Starreveld score was 10. AUC for Starreveld score was 0.54 and for Barr score 0.38, indicating poor discriminating power. Inter-observer agreement was 0.49-0.52 4 (Starreveld) and 0.44 (Barr), which is considered moderate. Intra-observer agreement was 0.52- 0.71 (Starreveld) and 0.62- 0.76 (Barr). Conclusion The Starreveld scoring method to assess fecal loading on a plain abdominal radiograph is of limited value in the diagnosis of childhood constipation.

Original languageEnglish
Pages (from-to)1789-1793
Number of pages5
JournalPediatric Radiology
Issue number11
Publication statusPublished - Nov 2010
Externally publishedYes


  • Abdominal radiograph
  • Child
  • Constipation
  • Scoring


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