Comparative analysis of three fecal continence scoring systems in anorectal malformations: inter-score agreement and prognostic factors
Pediatric Surgery International, cilt.42, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 42 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s00383-026-06491-7
- Dergi Adı: Pediatric Surgery International
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Agreement analysis, Anorectal malformation, Fecal continence, Holschneider score, Kelly score, Templeton score
- Açık Arşiv Koleksiyonu: AVESİS Açık Erişim Koleksiyonu
- Çukurova Üniversitesi Adresli: Evet
Özet
Purpose: To evaluate inter-score correlation and categorical agreement among the Kelly, Holschneider, and Templeton fecal continence scores in patients with anorectal malformations (ARM), and to identify predictors of poor continence. Methods: In this retrospective single-center cohort, 110 surgically treated ARM patients (2007–2017) were assessed at latest follow-up using all three scores. Correlation was tested with Spearman analysis, categorical agreement with weighted kappa, and independent risk factors with multivariable logistic regression for each scoring system. Results: Correlations were moderate across all pairs (ρ = 0.52–0.68; p < 0.001). Agreement was substantial between Kelly–Holschneider (κ = 0.652) and Holschneider–Templeton (κ = 0.684), but moderate between Kelly–Templeton (κ = 0.595). Poor continence rates differed by instrument (Kelly 18.2%, Holschneider 10.9%, Templeton 17.3%). Independent predictors of poor continence varied by scoring system: weak anal tone and fecal incontinence for Kelly, urinary incontinence for Holschneider, and male sex and systemic pathology for Templeton. Conclusion: Although the three scores are correlated, clinically meaningful categorical discordance exists. Single-score assessment may therefore be misleading. Combined use of multiple validated continence scores with objective functional assessment is recommended for comprehensive ARM follow-up.