Development and validation of a risk prediction model for functional constipation in school-aged children.
Source: PubMed, NCBI / U.S. National Library of Medicine
To identify independent risk factors for functional constipation (FC) in school-aged children, and to develop and internally validate a nomogram-based risk prediction model for early screening of high-risk populations. In this single-center, retrospective, cross-sectional case-control study, we enrolled 467 school-aged children who presented to the Constipation Clinic or Department of Child Health Care at Wuhan Children's Hospital between January 2024 and May 2025. Participants were randomly allocated into a derivation cohort (n = 326) and an internal validation cohort (n = 141) in a 7:3 ratio. Children in the derivation cohort were classified as FC or healthy controls based on Rome IV criteria. Independent risk factors were identified through multivariable logistic regression. A nomogram prediction model was then developed using the R software based on the results of the multivariable analysis. Model discrimination was evaluated by the area under the receiver operating characteristic curve (AUC-ROC), and calibration was assessed with the Hosmer-Lemeshow test. For internal validation, the predictive performance of the established nomogram was assessed on an independent validation cohort, which comprised 141 school-aged children (68 with FC and 73 healthy controls). This assessment was based on a receiver operating characteristic curve (ROC) analysis, with performance quantified by the area under the curve (AUC). Multivariable analysis identified th
Abstract
To identify independent risk factors for functional constipation (FC) in school-aged children, and to develop and internally validate a nomogram-based risk prediction model for early screening of high-risk populations. In this single-center, retrospective, cross-sectional case-control study, we enrolled 467 school-aged children who presented to the Constipation Clinic or Department of Child Health Care at Wuhan Children's Hospital between January 2024 and May 2025. Participants were randomly allocated into a derivation cohort (n = 326) and an internal validation cohort (n = 141) in a 7:3 ratio. Children in the derivation cohort were classified as FC or healthy controls based on Rome IV criteria. Independent risk factors were identified through multivariable logistic regression. A nomogram prediction model was then developed using the R software based on the results of the multivariable analysis. Model discrimination was evaluated by the area under the receiver operating characteristic curve (AUC-ROC), and calibration was assessed with the Hosmer-Lemeshow test. For internal validation, the predictive performance of the established nomogram was assessed on an independent validation cohort, which comprised 141 school-aged children (68 with FC and 73 healthy controls). This assessment was based on a receiver operating characteristic curve (ROC) analysis, with performance quantified by the area under the curve (AUC). Multivariable analysis identified the following independent risk factors for FC in school-aged children: shorter duration of exclusive breastfeeding, absence of any toilet training, child's concern over lack of privacy during defecation, complete unwillingness to defecate at school, frequent complaints of school-related stress, and suboptimal daily parent-child interaction time (all P < 0.05). The nomogram demonstrated excellent discrimination in the derivation cohort (AUC 0.88, 95% CI 0.85-0.92; sensitivity 74%, specificity 86%) with good calibration. Performance remained robust in the validation cohort (AUC 0.84, 95% CI 0.78-0.90; sensitivity 70%, specificity 82%). Incorporating key modifiable factors from type of infant feeding, toilet training, school environment, psychological adaptation, and parent-child interaction, the developed nomogram provides a simple, intuitive, and feasible clinical tool. It demonstrates good discriminative ability and predictive accuracy, offering a practical and actionable guide for the early identification of school-aged children at high risk of FC and for informing targeted preventive interventions.