Pediatric Rome IV diagnosis agreement is greater than agreement on diagnostic testing

Background Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. Methods Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re‐administered within 3 months. Inter‐rater and intra‐rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. Key Results Thirty‐four raters completed the initial survey of whom thirty‐one (91%) completed the repeat survey. Overall inter‐rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra‐rater agreement was 76%. In contrast, overall inter‐rater agreement on diagnostic testing was