A really good study, in my view, is one that provides useful data and 100% backs up what I want it to find.

N Yallanki et al JPGN 2023; 76: 295-299. Inter and Intraobserver Variation in Interpretation of Fecal Loading on Abdominal Radiographs

Methods: Electronic records of 100 children seen in the emergency room for gastrointestinal symptoms who had an abdominal radiograph performed were included. Four physicians from each specialty including gastroenterology, radiology, and emergency medicine interpreted the radiographs independently.

Key findings:

• Overall agreement among all providers: 40.8%. Fixed margin kappa 0.18
• Intradepartmental agreement: 41.5% for Peds GI, 36.7% for Peds EM, and 47.3% for Peds Radiology.

My takes:

1. The only surprising finding was the low intradepartmental agreement for Peds EM; many of my colleagues have insisted that all Peds EM think everyone has a high fecal burden (so there should have been uniform agreement)
2. This study reinforces expert guidance to avoid reliance on AXRs for the diagnosis of constipation

Related blog posts:

• Quality Improvement: Fewer Xrays for Constipation
• What’s Wrong with Ordering an AXR for Constipation in the ER?
• Improving ER Performance for Suspected Constipation
• Key to Reducing Unnecessary AXRs: Individualized Metrics
• Constipation Action Plan: Better Instructions, Fewer Phone Calls
• Updated Pediatric Expert Constipation Guidelines | gutsandgrowth
• Don’t Let the Chief of Staff Review This Constipation Study
• Is the Rectal Exam Obsolete?
• Diagnosis and Misdiagnosis of Constipation
• Diagnostic tests hardly ever help patients poop
• How to Rectify the Problem of Missed Impactions