Clinical utility of the Pediatric Bowel Management Scoring Tool in guiding management of childhood constipation—a prospective, multicenter study

To evaluate the clinical utility of the Pediatric Bowel Management Scoring Tool (PBMST) by assessing its association with healthcare practitioner (HCP) treatment decisions and patient-reported quality of life in children with constipation using transanal irrigation (TAI). A multicenter prospective cohort study was conducted in 121 children (4-18 years) with functional or organic constipation, either newly initiating (NTP) or currently receiving (CTP) TAI. The PBMST and PedsQL™ 4.0 quality of life questionnaires were completed at baseline and one-month follow-up. PBMST outcomes range from 0 to 22; higher scores indicate worse bowel management. HCPs, blinded to PBMST scores, classified treatment strategies as adequate, sub-optimal, or inadequate. Associations between PBMST scores and HCP treatment decisions were analyzed using multiple linear regression, adjusting for age, sex, and participant type (NTP or CTP). Correlations between PBMST and PedsQL™ scores, as well as associations between TAI adherence, duration of TAI use, and predictors of high adherence (MARS-5 ≥ 23), were examined. Survey completion rates were 93% at baseline and 88% at follow-up. Higher PBMST scores were associated with HCP-rated inadequate treatment (B = 2.44, SE = 0.72, p = 0.001), independent of age, sex, and participant type (NTP or CTP). PBMST scores were negatively correlated with PedsQL™ scores (r = - 0.47, p < 0.001). No significant associations were found between adherence and TAI duration or PBMST scores. Lower adherence to TAI was associated with older age and participants reporting that TAI was too time-consuming.Conclusion: The PBMST is a valid tool reflecting symptom severity, correlating with HCP treatment decisions and patient-reported quality of life in children with functional or organic constipation using TAI.