Comparative analysis of three fecal continence scoring systems in anorectal malformations: inter-score agreement and prognostic factors.

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.