Creation and Initial Evaluation of a Stool Form Scale for Children

Abstract

Objective-To develop a pediatric stool form rating scale and determine its inter-rater reliability, intra-rater reliability, and agreement amongst pediatric gastroenterologists.Study design-An ordinal stool scale with five categorical stool form types was created based on the Bristol Stool Form Scale (BSFS), and 32 color two-dimensional stool photographs were shown to 14 pediatric gastroenterologists. Each gastroenterologist rated the stool form depicted in each photograph using the modified stool scale. Ten gastroenterologists agreed to re-rate the stool form depicted in each photograph a minimum of six months after the first rating.Results-448 ratings were completed; 430 (94%) of all ratings were within at least one category type of the most common (modal) rating for each photograph. Eight (25%) stool photographs had complete agreement amongst all raters. Inter-rater and intra-rater reliability was high with a single measure intraclass correlation of 0.85 (95% CI: 0.78-0.91; P<0.001) and 0.87 (95% CI: 0.81-0.92; P<0.001) respectively.Conclusion-A modified pediatric BSFS provided a high degree of inter-rater reliability, intrarater reliability, and agreement amongst pediatric gastroenterologists.Alterations in stool form and frequency are associated with numerous gastrointestinal disorders ranging from inflammatory disorders (e.g. ulcerative colitis) to functional gastrointestinal disorders (e.g. irritable bowel syndrome). Diagnostic criteria for gastrointestinal disorders may depend, in part, on whether changes in stool form are associated with symptoms 1 . Stool form may also guide assessment of treatment efficacy or determine the clinical status of a disorder. Therefore, assessment of stool form may aide clinicians in diagnosis and management of underlying gastrointestinal disorders, and may serve as a measurable clinical outcome employed in the clinical research setting 2 , 3.© 2010 Mosby, Inc. All rights reserved.Correspondence/Reprint Request Contact: Bruno Chumpitazi, M.D., M.P.H., Texas Children's Hospital, 6701 Fannin Street, CCC 1010.00, Houston, TX 77030, bpchumpi@texaschildrens.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An often used measure of stool form is the Bristol Stool Form Scale (BSFS) 4 . This scale allows one to classify stool form into seven types ranging from "separate hard lumps like nuts" (type 1) to "watery, no solid pieces, entirely liquid" (type 7) 5. However, the BSFS was validated in adults as a measure of stool transit rather than as a means of identifying stool form 4. Despite this fact, it has been used to evaluate stoo...

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