Standardizing the assessment of diarrhea in clinical trials: results of an interobserver agreement study

Abstract

Interobserver agreement was determined between nurses and parents using a standard method of assessing diarrheal stools. The study population consisted of patients less than three years of age hospitalized at The Hospital for Sick Children, Toronto, Canada. Stool samples were independently categorized by observer pairs within minutes of being obtained from children with and without diarrhea as: watery--liquid, no solid elements; loose--liquid with solid elements; pasty--like a paste; formed--normal solid. Watery and loose stools were regarded as abnormal and indicative of diarrhea. Teaching sessions were conducted for nursing shifts, while parents were instructed prior to each observation. In the nurses' agreement study, each stool specimen was examined by the nurse providing care to the patient from whom the stool was obtained and a nurse not looking after the patient. Parents' assessments were also compared with nurses' assessments. Finally, parents' assessments were compared with each other. In the first group, agreement beyond chance for presence or absence of diarrhea measured by kappa was 0.78 (95% confidence intervals (CI) 0.55-1.0). The observed agreement on 148 pairs of observations between parents and nurses was 75% (kappa = 0.5; 95% CI 0.36-0.64). Between-parent agreement on 30 other paired observations was 77% (kappa = 0.54; 95% CI 0.24-0.84). Teaching parents about the four categories is a potentially useful adjunct for assessment of diarrheal stools in children.

Assessment of fecal output in patients receiving enteral tube feeding: validation of a novel chart

“…Interestingly, the reliability of fecal consistency characterization in the current study (k ¼ 0.91) was higher, despite the use of identical consistency descriptors, which may be Assessment of fecal output in enteral feeding K Whelan et al attributable to the use of color photographs as opposed to line drawings. Furthermore, the reliability shown here is much higher than that of a previous study where nurses characterized fecal consistency using four verbal descriptors (k ¼ 0.25) (Allen et al, 1994).…”

“…Given that both of these are impractical in the clinical setting, nurses routinely characterize fecal output visually. However, nurse characterization of fecal consistency has been shown to be only fairly reliable (Allen et al, 1994), while nurse characterization of fecal weight may overestimate the actual amount (Daffurn et al, 1994).…”

Measurement Issues in Trials of Pediatric Acute Diarrheal Diseases: A Systematic Review

“…Aside from a single stool-consistencyscoring system, previously shown to be reliable, 31 the majority of instruments used either are currently unpublished or no citation regarding their development or measurement properties has been provided. If we consider the importance of a reliable instrument in the measurement of diarrhea incidence or duration, the consistency of stool (formed versus loose versus liquid) is a pivotal discriminator for determining the incidence of diarrhea (number of diarrhea stools in the preceding 24 hours) and its resolution (duration of diarrhea).…”

Enteral feeding: the effect on faecal output, the faecal microflora and SCFA concentrations

“…The reliability of nurses in reporting diarrhoea has been investigated in thirty-six paediatric in-patients (Allen et al 1994). Following independent inspection of thirty faecal samples, two different nurses agreed on the presence or absence of diarrhoea on 90 % of occasions (percentage agreement corrected for chance agreement, k 0 .…”

“…The reported agreement beyond chance between nurses visually characterising faecal consistency ranges from fair (k 0 . 25; Allen et al 1994) to substantial (k 0 . 68; Bliss et al 2001), although none of these patients was receiving ETF (Landis & Koch, 1977).…”