Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.
Gastroenterology Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Bologna, Italy.
Clin Gastroenterol Hepatol. 2021 Feb;19(2):339-348.e7. doi: 10.1016/j.cgh.2020.02.055. Epub 2020 Mar 18.
BACKGROUND & AIMS: Hospitalization is associated with inadequate colon cleansing before colonoscopy. We aimed to identify factors associated to inadequate colon cleansing among inpatients, and to derive and validate a model to identify inpatients with inadequate cleansing.
We performed a prospective observational study at 12 hospitals in Italy. Consecutive adult inpatients scheduled for colonoscopy for any indication were enrolled from February through May 2019 (derivation cohort, n = 1016) and from June through August 2019 (validation cohort, n = 508). Inadequate cleansing was defined as Boston bowel preparation scale scores below 2 in any colon segment. We performed multivariate logistic regression to identify factors associated with inadequate cleansing.
In the combined cohorts, 1032 patients (68%) had adequate colon cleansing. Physicians' meetings to optimize bowel preparation (odds ratio [OR], 0.42; 95% CI, 0.27-0.65), written and oral instructions to patients (OR, 0.48; 95% CI, 0.36-0.65), admission to gastroenterology unit (OR, 0.71; 95% CI, 0.51-0.98), split-dose regimens (OR, 0.27; 95% CI, 0.20-0.35), a 1-liter polyethylene glycol-based bowel purge (OR, 0.39; 95% CI, 0.23-0.65), and 75% or more intake of bowel preparation (OR, 0.09; 95% CI, 0.05-0.15) significantly reduced odds of inadequate colon cleansing. Alternatively, bedridden status (OR, 2.14; 95% CI, 1.55-2.98), constipation (OR, 2.16; 95% CI, 1.55-3.0), diabetes mellitus (OR, 1.61; 95% CI, 1.18-2.20), use of anti-psychotic drugs (OR, 3.26; 95% CI, 1.62-6.56), and 7 or more days of hospitalization (OR, 1.02; 95% CI, 1.00-1.04) increased risk of inadequate colon cleansing. We developed a model to identify patients with inadequate cleaning using data from patients in the derivation cohort and tested it in the validation cohort. Calibration values were P = .218 for the discrimination cohort and P = .232 for the validation cohort. Discrimination values were c-statistic, 0.78 (95% CI, 0.74-0.81) for the discrimination cohort and c-statistic, 0.73 (95% CI, 0.69-0.78) for the validation cohort. We developed app for use by clinicians.
In a prospective observational study, we identified setting-, patient- and preparation-related factors that affect colon cleansing among inpatients. We derived and validated a model to identify patients with inadequate preparation and developed an app for clinicians. ClinicalTrials.gov no: NCT03925506.
住院患者在结肠镜检查前结肠清洁不充分与住院相关。我们旨在确定与住院患者结肠清洁不充分相关的因素，并建立和验证一种识别结肠清洁不充分的模型。
我们在意大利的 12 家医院进行了前瞻性观察性研究。2019 年 2 月至 5 月（推导队列，n=1016）和 6 月至 8 月（验证队列，n=508）期间，连续纳入因任何原因计划行结肠镜检查的成年住院患者。采用波士顿肠道准备量表评分，任何结肠段评分低于 2 分为清洁不充分。我们进行多变量逻辑回归分析，以确定与清洁不充分相关的因素。
在合并队列中，1032 例患者（68%）的结肠清洁充分。医生会议以优化肠道准备（比值比[OR]，0.42；95%置信区间，0.27-0.65）、书面和口头告知患者（OR，0.48；95%置信区间，0.36-0.65）、入住胃肠病学病房（OR，0.71；95%置信区间，0.51-0.98）、分剂量方案（OR，0.27；95%置信区间，0.20-0.35）、1 升聚乙二醇基肠道冲洗剂（OR，0.39；95%置信区间，0.23-0.65）和 75%或更多的肠道准备摄入量（OR，0.09；95%置信区间，0.05-0.15）显著降低了结肠清洁不充分的几率。相反，卧床状态（OR，2.14；95%置信区间，1.55-2.98）、便秘（OR，2.16；95%置信区间，1.55-3.0）、糖尿病（OR，1.61；95%置信区间，1.18-2.20）、使用抗精神病药物（OR，3.26；95%置信区间，1.62-6.56）和住院 7 天或以上（OR，1.02；95%置信区间，1.00-1.04）增加了结肠清洁不充分的风险。我们使用推导队列中患者的数据建立了一种识别清洁不充分患者的模型，并在验证队列中进行了测试。在鉴别队列中，校准值为 P =.218，在验证队列中为 P =.232。鉴别值为鉴别队列的 C 统计量为 0.78（95%置信区间，0.74-0.81），验证队列的 C 统计量为 0.73（95%置信区间，0.69-0.78）。我们为临床医生开发了一个应用程序。
在一项前瞻性观察性研究中，我们确定了影响住院患者结肠清洁的环境、患者和准备相关因素。我们建立并验证了一种识别准备不充分患者的模型，并为临床医生开发了一个应用程序。临床试验注册：NCT03925506。
