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Validation of the Constipation Scoring System for the pediatric population. A new tool to be use for constipated children.
Maria Karolina Velame S. Santos, Medical student1, Glicia Estevam de Abreu, PhD1, Clara Nunes Pamponet, Medical student1, Maria Thais Calasans, Nurse1, Thiago Masashi Taniguchi, Doctor1, Josť Murillo Netto, PhD2, Ubirajara  de Oliveira  Barroso Jr., PhD1.
1Bahiana School of Medicine and Public Health, SALVADOR, Brazil, 2Federal University of Juiz de Fora, Juiz de Fora, Brazil.

Background: Lower urinary tract dysfunction is usually associated with constipation. Rome criteria are used to identify constipation and its subtypes; however, it does not assess its severity. Therefore, constipation scoring system (CSS) is a tool that can measure the constipation's severity and may help physicians to decide the best management of this dysfunction. Although it is validated to adult population, this score was still not yet validated for children. This study aims to adapted and validate the CSS for the pediatric population. Methods: From January to May 2022, children and adolescents aged 4 to 17 years who did not have anatomical or neurological abnormalities of the gastrointestinal tract and who were randomly selected from a general consultation with pediatrician were evaluated. ROME IV criteria were used as reference test and was compared to the adapted version for the pediatric population of the CSS. Adaptation was first applied to 30 children to check comprehension. After adjusting the questionnaire, it was applied to another 100 children. Afterward, the official adapted questionnaire was performed through test-retest after two weeks. Results: One hundred patients with a mean age of 8,61+3,25, being 51 (51%) male, were evaluated. According to the score obtained, no children had a severe constipation (21-30), 9 had moderate (11-20), and 91 had minor (1-10) constipation. The convergent validity of the pediatric version of the CSS showed a significant correlation to the Rome IV criteria evinced by the positive Spearman correlation (r2) of 0.6 (p<0.001). Between the test-retest responses, the score had a Cronbach's Alpha of 0.97. A high level of internal consistency was also obtained when each item of the questionnaire was assessed separately, revealing an adequate internal reliability. Conclusions: The CSS was well adapted and accepted by the pediatric population, demonstrating the linguistic and psychometric validity of this version of the score to assist the diagnosis of functional constipation. This was the first step to enable the use of this score in other countries and cultures and to allow the evaluation of the constipation's severity in children.


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