Incontinence Symptom Index-Pediatric: development and initial validation of a urinary incontinence instrument for the older pediatric population.

Abstract

Although urinary incontinence is common in children, no validated pediatric instruments exist for measuring urinary incontinence symptoms and bother. We developed and validated a patient reported pediatric survey for urinary incontinence measurement. The Incontinence Symptom Index-Pediatric is an 11-item instrument comprising 2 domains, that is 1) impairment and 2) symptom severity, including subdomains for stress urinary incontinence, urge urinary incontinence, insensate urinary incontinence, nocturnal urinary incontinence and pad use. The survey was self-administered twice, 2 weeks apart, to boys and girls ages 11 to 17 years. Children completed the survey independently. Cases consisted of patients presenting to pediatric urology clinic with the chief complaint of urinary incontinence. Controls consisted of healthy children presenting for evaluation up at a general pediatric practice. Formal validation analysis was performed. A total of 19 subjects per arm completed at least 1 survey. Internal consistency was good with a Cronbach's alpha of 0.84 for the complete instrument. Item-scale correlations were greater than 0.60 for all except 1 item. Test-retest reliability was also good (r = 0.97, p <0.0001). Discriminative validity was good with a total severity scale score of 9.3 in wet children and 0.7 in controls (p <0.0001). Impairment scale scores differed by 2.2 points (p <0.0001). Mean scores differed significantly between subscales for all domains except pad use. The most dramatic difference was in the urge urinary incontinence domain, which differed by a mean of 3.6 points (p = 0.0002). This pilot study provides initial validation of a survey instrument for urinary incontinence in children and adolescents. This instrument can be used in children ages 11 to 17 years to objectively and reproducibly measure patient reported urinary incontinence.