Comparison of fecal continence and bowel function scoring systems following anorectal malformation repair: a systematic review.

In 30 seconds

This systematic review assessed whether fecal continence and bowel function scoring systems give comparable results when applied to the same cohorts after anorectal malformation repair. Fifteen studies published from 2012 to 2025 were included, with individual sample sizes of 20–267 participants. Only one study reported numerical agreement: weighted κ values for four score pairs ranged from 0.256 to 0.343. Other studies reported category discordance or differences in group-level findings. The evidence suggests that commonly used instruments may provide non-equivalent information, but it does not establish that any system is superior or that the instruments are interchangeable.

Key findings

• Across four score pairs in the sole study reporting numerical agreement, weighted κ values ranged from 0.256 to 0.343.
• Krickenbeck was used in 14 of 15 studies (93%), while Kelly was used in nine (60%).
• In 12 studies, blinding between instrument administrations was unreported.

Why it matters

Different scoring systems may characterize bowel outcomes differently in children after anorectal malformation repair, complicating comparisons across studies and interpretation of reported outcomes. The limited agreement data do not support treating scores as interchangeable. More standardized comparative assessment would help clarify what each instrument measures and improve the consistency of outcome reporting.

What to keep in mind

Comparable agreement estimates were sparse, and only one study reported numerical inter-system agreement. Blinding between instrument administrations was unreported in 12 studies.