KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands.
J Pediatr Gastroenterol Nutr. 2019 Feb;68(2):207-213. doi: 10.1097/MPG.0000000000002153.
The Bristol Stool Form Scale (BSFS) is inadequate for non-toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate interobserver reliability of stool consistency assessment among parents, nurses, and medical doctors (MDs) using the BITSS.
In this multicenter cross-sectional study (2016-2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic.
A total of 2462 observers participated: 1181 parents (48.0%), 624 nurses (25.3%), and 657 MDs (26.7%). The best-performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ-value was 0.72 (95% CI 0.59-0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1-3), formed (BSFS type 4), loose (BSFS types 5 and 6), or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83 to 96% (average: 90%). The overall proportion of correct allocations was 72.8%.
BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non-toilet trained children in clinical practice and research. A multilanguage translated version of the BITSS can be downloaded at https://bitss-stoolscale.com/.
布里斯托粪便形态量表（BSFS）不适合未经如厕训练的儿童。为此开发了布鲁塞尔婴幼儿粪便形态量表（BITSS），该量表由包含婴幼儿粪便的 7 张尿布照片组成。我们旨在评估家长、护士和医生使用 BITSS 评估粪便一致性的观察者间可靠性。
在这项多中心横断面研究（2016-2017 年）中，根据 BSFS 对 BITSS 照片进行评分。使用整体完全一致比例和线性加权κ统计来评估 BITSS 的可靠性。
共有 2462 名观察者参与：1181 名家长（48.0%）、624 名护士（25.3%）和 657 名医生（26.7%）。表现最好的 BITSS 照片与 BSFS 类型 7（87.5%）和类型 4（87.6%）相对应，其次是与 BSFS 类型 6（75.0%）、BSFS 类型 5（68.0%）、BSFS 类型 1（64.8%）和 BSFS 类型 3（64.6%）相对应。表现最差的 BITSS 照片与 BSFS 类型 2（49.7%）相对应。整体加权κ 值为 0.72（95%CI 0.59-0.85；一致性好）。基于这些结果，根据粪便组对照片进行分类为硬便（BSFS 类型 1-3）、成型便（BSFS 类型 4）、稀便（BSFS 类型 5 和 6）或水样便（BSFS 类型 7）。根据这个新的分类系统，每张照片的正确分配范围为 83%至 96%（平均：90%）。整体正确分配比例为 72.8%。
BITSS 与 BSFS 具有良好的一致性。使用新分类的 BITSS 照片，BITSS 可用于临床实践和研究中评估未经如厕训练的儿童的粪便。BITSS 的多语言翻译版本可在 https://bitss-stoolscale.com/ 下载。
