Assessment of the Turkish Version of the Kingʼs Stool Chart for Evaluating Stool Output and Diarrhea Among Patients Receiving Enteral Nutrition

Dağ, Gülten Sucu; Dicle, Aklime; Saka, Osman; Whelan, Kevin

doi:10.1097/sga.0000000000000114

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…As mentioned earlier, we used the King's stool chart, 13 which was specifically developed to assess fecal output in patients on EN in this study, instead of using the more generalized definition of >3 bowel movements per day. The King's stool chart has been validated in tube‐fed patients and showed concurrent validity and inter‐rater reliability, 13,16–18 including in our RCT, as an excellent agreement was observed with an intra‐class correlation coefficient of 0.878 12 . In the present study, post‐feeding diarrhea occurred in 37.1% of hospitalized patients in general medical wards, which is similar to the 39–41% from other studies in the same setting of general medical patients on EN feeding 15,19 …”

Section: Discussionsupporting

confidence: 86%

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

Sripongpun

Lertpipopmetha

Chamroonkul

et al. 2021

J of Gastro and Hepatol

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Background and Aim Clostridium difficile‐associated diarrhea (CDAD) and enteral nutrition (EN)‐associated diarrhea are the most common recognized etiologies of nosocomial diarrhea. However, in clinical practice, the data regarding how each etiology contributes to the diarrheal episodes are limited. We identify the causes and factors associated with post‐feeding diarrhea. Methods Using the data of patients enrolled in “Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial”, the randomized controlled trial showed no difference in diarrheal incidences between fiber‐added and fiber‐free formulas. Hence, we analyzed the data of all enrolled patients. The causes of diarrhea were classified according to pre‐specified definitions. The factors associated with diarrhea were analyzed using logistic regression. Results Diarrhea was found in 37.3% (n = 31/83). The most common cause was medication associated (61.3%). CDAD and EN‐associated diarrhea were found in only 9.7% and 6.5%, respectively. Patients with baseline albumin <3 g/dL and underlying cerebrovascular disease were more likely to develop diarrhea (adjusted odds ratio 5.70, 95% confidence interval 1.79–20.51, and adjusted odds ratio 10.83, 95% confidence interval 2.96–48.57, respectively). Compared with those without diarrhea, the length of hospital stay in CDAD patients was significantly longer (+23.1 days, P = 0.02), a trend of longer hospital stay in patients with diarrhea from other causes was observed (+3.2 days, P = 0.096). Conclusions Our study found that the most common cause of post‐feeding diarrhea is medication associated. Review and cessation of possible drugs should be undertaken before EN modification. CDAD accounts for <10% of diarrhea causes, but it impacts the clinical outcome and should be identified and treated properly.

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Section: Discussionsupporting

confidence: 86%

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

Sripongpun

Lertpipopmetha

Chamroonkul

et al. 2021

J of Gastro and Hepatol

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“…Stool assessment was recorded for every patient's bowel movement by the nursing staff using the King's Stool Chart . The King's Stool Chart has been validated in patients receiving enteral tube feeding, has concurrent validity and interrater reliability, and is suitable for both research and clinical use . All nursing staff were trained and then performed a pretraining and posttraining evaluation questionnaire for using the King's Stool Chart before they assessed the patients in the study.…”

Section: Methodsmentioning

confidence: 99%

“…40 The King's Stool Chart has been validated in patients receiving enteral tube feeding, has concurrent validity and interrater reliability, and is suitable for both research and clinical use. 16,[40][41][42] All nursing staff were trained and then performed a pretraining and posttraining evaluation questionnaire for using the King's Stool Chart before they assessed the patients in the study. The King's Stool Chart applies a score to each stool which is then summed into a daily fecal score; a score of 15 or more on any day was classified as diarrhea.…”

Section: Stool Assessmentmentioning

confidence: 99%

Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial

Lertpipopmetha

Kongkamol

Sripongpun

2018

J Parenter Enteral Nutr

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Background Diarrhea in enteral tube‐fed patients is not uncommon and can lead to unfavorable outcomes. Fiber in enteral nutrition (EN) formula might play a role in postfeeding diarrhea. Theoretically, soluble fiber is beneficial for both prevention and treatment of postfeeding diarrhea, but different types of soluble fiber may not provide the same effect. This study aims to determine whether supplementation with psyllium in standard EN reduces the incidence of diarrhea in tube‐fed patients. Methods We conducted a prospective, randomized, double‐blind, controlled study in general medical wards patients who were expected to receive EN for ≥5 days. Exclusion criteria were hemodynamic instability, known significant gastrointestinal problems, and recent pancreatitis. Eligible patients were randomized to receive either Mucilin SF (15.2 g/L)‐added Blendera (psyllium‐added formula: Psyllium group [PG]) or Blendera (fiber‐free formula: Control group [CG]). All patients were given EN for 10 days or until discharge/oral intake/death. Bowel movements (BMs) were monitored using King's Stool Chart. Results Eighty‐three patients were enrolled, 42 in the PG and 41 in the CG. Baseline characteristics were similar. The proportion of patients with ≥1 day of diarrhea (King's stool score ≥15) was comparable (42.9% vs 31.7%; P = 0.41, in PG and CG, respectively). There were no significant differences in the frequency of daily BMs and the median diarrhea score between PG and CG (3 vs 2, P = 0.06 and 3.8 vs 2.4, P = 0.42, respectively). Conclusion Supplementation with psyllium showed no beneficial effect on reducing incidence of diarrhea in general medical patients receiving EN. This study was registered on Thai Clinical Trials Registry (http://www.clinicaltrials.in.th: TCTR identification number TCTR20170821004).

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“…Although the leading cause of diarrhea during ETF is unclear, medicines probably underlie most cases of nosocomial diarrhea due to gut toxicity and/or disruption of normal enteric bacterial flora [3]. Antibiotics and, in particular, combinations of two or more antibiotics [4] are associated with diarrhea [5,6]. In addition, several other factors such as gut colonization with enteropathogens, e.g.…”

Section: Introductionmentioning

confidence: 99%

The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients

Schmidt

Kulig²,

Winter³

et al. 2019

Clinical Nutrition

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Assessment of the Turkish Version of the Kingʼs Stool Chart for Evaluating Stool Output and Diarrhea Among Patients Receiving Enteral Nutrition

Cited by 5 publications

References 20 publications

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube‐Fed Patients: A Prospective, Randomized, and Controlled Trial

The effect of a natural food based tube feeding in minimizing diarrhea in critically ill neurological patients

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