Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing

Authors: KAUL, ISHA - Baylor College Of Medicine; STAGGS, VINCENT - Children'S Mercy Hospital; BAGHERIAN, AMBER - Children'S Mercy Hospital; ALI, AMNA - Rice University; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); COLOMBO, JENNIFER - Children'S Mercy Hospital; SCHURMAN, JENNIFER - Children'S Mercy Hospital; CHUMPITAZI, BRUNO - Children'S Nutrition Research Center (CNRC); FRIESEN, CRAIG - Children'S Mercy Hospital

Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/30/2022
Publication Date: 3/13/2022
Citation: Kaul, I., Staggs, V.S., Bagherian, A., Ali, A., Shulman, R.J., Colombo, J.M., Schurman, J.V., Chumpitazi, B.P., Friesen, C.A. 2022. Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing. Neurogastroenterology & Motility. https://doi.org/10.1111/nmo.14355.
DOI: https://doi.org/10.1111/nmo.14355

Interpretive Summary: The so-called Rome Criteria are used to define common disorders called Disorders of Brain-Gut Interaction (for example, irritable bowel syndrome) that often are associated with abdominal pain. It is unclear if these criteria help healthcare providers decide what tests might be needed to exclude other diseases that might be confused with Disorders of Brain-Gut Interaction. This study showed that the Rome Criteria can help pediatric gastroenterologists diagnose Disorders of Brain-Gut Interaction but they do not help deciding what diagnostic testing might be needed. This study helps to provide a better quality of life for children that encounter gut-related issues.

Technical Abstract: Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis (es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re-administered within 3 months. Inter-rater and intra-rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. Thirty-four raters completed the initial survey of whom thirty-one (91%) completed the repeat survey. Overall inter-rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra-rater agreement was 76%. In contrast, overall inter-rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra-rater agreement was only 57%. Between-physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2–2.0, p = 0.015). Higher intra-rater agreement was noted for diagnostic testing in faculty when compared to fellows (p = 0.009). In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing.