Whelan Kevin, Judd Patricia A, Preedy Victor R, Taylor Moira A
Diet and Gastrointestinal Health, Nutritional Sciences Division, King's College London, London, UK.
JPEN J Parenter Enteral Nutr. 2008 Mar-Apr;32(2):160-8. doi: 10.1177/0148607108314769.
An accurate and convenient method for characterizing fecal output and a consistent threshold for classifying diarrhea in patients receiving enteral nutrition are required. The aim of this study is to covertly assess the construct and concurrent validity of a chart for characterizing fecal output and classifying diarrhea in patients receiving enteral nutrition.
The chart was used to monitor fecal output in patients receiving enteral nutrition for a total of 280 patient days. Nurses characterized 291 fecal samples, of which 84 underwent measurement of fecal water using lyophilization and 60 underwent Clostridium difficile enterotoxin analysis using enzyme-linked immunosorbent assay. Construct and concurrent validity was assessed covertly to measure the true performance of the chart in a real-life clinical and research context.
Use of the chart demonstrated higher fecal frequency (P <or= .04), heavier stools (P <or= .167), more unformed stools (P <or= .001), higher daily fecal scores (P <or= .001), and higher incidence of diarrhea (P <or= .002) on days when patients had severe hypoalbuminemia, were receiving antibiotics, or had a recent positive C difficile assay, demonstrating construct validity. The water content of samples assigned to hard and formed (62.0%), soft and formed (72.1%), loose and unformed (79.3%), and liquid (87.9%) categories was significantly different (P < .001), demonstrating concurrent validity.
Under covert assessment, the chart demonstrated construct validity for characterizing fecal output, daily fecal score, and diarrhea, together with concurrent validity for characterizing fecal consistency. Use of the chart in clinical practice and research will standardize the characterization of fecal output and classification of diarrhea in patients receiving enteral nutrition.
需要一种准确且便捷的方法来描述粪便排出情况，以及确定肠内营养患者腹泻分类的一致阈值。本研究的目的是暗中评估用于描述接受肠内营养患者粪便排出情况和腹泻分类的图表的结构效度和同时效度。
该图表用于监测接受肠内营养患者的粪便排出情况，共监测了280个患者日。护士对291份粪便样本进行了描述，其中84份使用冻干法测量了粪便水分，60份使用酶联免疫吸附测定法进行了艰难梭菌肠毒素分析。暗中评估结构效度和同时效度，以测量该图表在实际临床和研究环境中的真实性能。
使用该图表显示，在患者患有严重低白蛋白血症、正在接受抗生素治疗或近期艰难梭菌检测呈阳性的日子里，粪便频率更高（P≤0.04）、粪便更重（P≤0.167）、不成形粪便更多（P≤0.001）、每日粪便评分更高（P≤0.001）以及腹泻发生率更高（P≤0.002），证明了结构效度。归类为硬便和成形便（62.0%）、软便和成形便（72.1%）、稀便和不成形便（79.3%）以及水样便（87.9%）的样本的水分含量存在显著差异（P<0.001），证明了同时效度。
在暗中评估下，该图表显示出在描述粪便排出情况、每日粪便评分和腹泻方面具有结构效度，以及在描述粪便稠度方面具有同时效度。在临床实践和研究中使用该图表将使接受肠内营养患者的粪便排出情况描述和腹泻分类标准化。
