Location: Children's Nutrition Research CenterTitle: Creation and initial evaluation of a stool form scale for children) Author
Submitted to: Journal of Pediatrics
Publication Type: Peer reviewed journal
Publication Acceptance Date: 4/23/2010
Publication Date: 10/1/2010
Citation: Chumpitazi, B.P., Lane, M.M., Czyewski, D.I., Weidler, E.M., Swank, P.R., Shulman, R.J. 2010. Creation and initial evaluation of a stool form scale for children. Journal of Pediatrics. 157(4):594-597. Interpretive Summary: Children often have bowel problems related to diet or other factors. Up until now, it was not possible to obtain an objective report from children of the appearance of their bowel movements. This study was the initial phase in designing a method to obtain this information. Experts in child intestinal problems were asked to rate the appearance of stools on a scale derived from the Bristol Stool Scale, which is used in adults to measure how fast food transits the intestinal tract. The experts showed that the modified scale that we devised was reliable in assessing the appearance of the stool. In the next phase of the study, we plan to test the ability of children to use the scale.
Technical Abstract: Alterations in stool form and frequency are associated with numerous gastrointestinal disorders, ranging from inflammatory disorders to functional gastrointestinal disorders. Diagnostic criteria for gastrointestinal disorders may depend, in part, on whether changes in stool form are associated with symptoms. 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 used in the clinical research setting. An often-used measure of stool form is the Bristol Stool Form Scale (BSFS). This scale allows one to classify stool form into 7 types ranging from “separate hard lumps like nuts” to “watery, no solid pieces, entirely liquid”. However, the BSFS was validated in adults as a measure of stool transit rather than as a means of identifying stool form. Despite this fact, it has been used to evaluate stool form in a variety of clinical studies including a population of healthy adults, adults with human immunodeficiency virus-related diarrhea, and adults with functional bowel disorders. It was recently adapted for the Spanish language. Despite its lack of validation, the Rome foundation has recommended that the BSFS be used for assessing stool form in adults with functional gastrointestinal disorders. Studies characterizing stool form in children have been conducted, but the pediatric scales used in these studies were never validated. Given the lack of a scale validated to assess stool form for use in adults or children, we sought to develop such a scale and assess its interrater reliability, intrarater reliability, and agreement when used by expert raters.