Aman Berthold Albert, Levy Elvira Ingrid, Hofman Benjamine, Vandenplas Yvan, Huysentruyt Koen
KidZ Health Castle, UZ Brussel, Brussels, Vrije Universiteit Brussel, Brussels, Belgium.
Day Care Centre, Vrije Universiteit Brussel, Brussels, Belgium.
Pediatr Gastroenterol Hepatol Nutr. 2021 Jan;24(1):38-44. doi: 10.5223/pghn.2021.24.1.38. Epub 2021 Jan 8.
Digital communication is becoming increasingly important in clinical practice and research. The finding that stool consistency can be evaluated similarly using either "in vivo" or photographic material by health care professionals will decrease subjective interpretation by parents. The primary outcome of this study was the reliability of stool consistency scoring using the Brussels Infant and Toddler Stool Scale (BITSS) between fresh stools and their photos; the secondary outcome was the inter-rater reliability based on the fresh stools.
Fresh stool samples from healthy children were collected in a day care center. These stools, and one month later the corresponding photos presented in a random order, were presented to 14 observers. Reliabilities were analyzed using absolute agreements and weighted and unweighted Cohen's κ.
In total, 202 samples were rated 576 times. Absolute agreement between photographic and real time assessment ranged between 71.1% and 83.3% among observers. This corresponded with substantial agreement (unweighted κ=0.70 [95% CI, 0.61-0.78]; weighted κ=0.86 [95% CI, 0.78-0.88]). The inter-observer agreement showed similar percentages of absolute agreement (81.4-82.0%) and κ-values corresponding with fair-to-moderate agreement.
Our findings suggest that the assessment of fresh stool consistency can also reliably be done on photographic material when using the BITSS. This opens opportunities in scientific surroundings and in our daily life communication with parents and caretakers.
数字通信在临床实践和研究中变得越来越重要。医疗保健专业人员发现，使用“活体”或照片材料评估粪便稠度的结果相似，这将减少家长的主观解读。本研究的主要结果是使用布鲁塞尔婴幼儿粪便量表（BITSS）对新鲜粪便及其照片进行粪便稠度评分的可靠性；次要结果是基于新鲜粪便的评分者间信度。
在日托中心收集健康儿童的新鲜粪便样本。将这些粪便以及一个月后随机排列的相应照片展示给14名观察者。使用绝对一致性以及加权和未加权的科恩κ系数分析信度。
总共对202个样本进行了576次评分。观察者之间照片评估与实时评估的绝对一致性在71.1%至83.3%之间。这对应着高度一致性（未加权κ=0.70[95%CI，0.61 - 0.78]；加权κ=0.86[95%CI，0.78 - 0.88]）。观察者间一致性显示出相似的绝对一致性百分比（81.4 - 82.0%）和对应着一般到中等一致性的κ值。
我们的研究结果表明，使用BITSS时，对新鲜粪便稠度的评估也可以在照片材料上可靠地进行。这为科研环境以及我们与家长和护理人员的日常交流开辟了机会。
