一种新的客观评分系统，用于临床评估粪便失禁。
New objective scoring system to clinically assess fecal incontinence.
机构信息
Colorectal Surgery, Garg Fistula Research Institute (GFRI), Panchkula 134113, Haryana, India.
Colorectal Surgery, Indus International Hospital, Mohali 140507, Punjab, India.
出版信息
World J Gastroenterol. 2023 Aug 7;29(29):4593-4603. doi: 10.3748/wjg.v29.i29.4593.
BACKGROUND
Several scoring systems are used to assess fecal incontinence (FI), among which, the most commonly used are Wexner and Vaizey's scoring systems. However, there are significant lacunae in these scoring systems, due to which they are neither accurate nor comprehensive.
AIM
To develop a new scoring system for FI that is accurate, comprehensive, and easy to use.
METHODS
A pro forma was made in which six types of FI were included: solid, liquid, flatus, mucous, stress, and urge. The weight for each FI was determined by asking a group of patients and laypersons to give a disability score to each type of FI from 0 to 100 (0- least, 100- maximum disability). The disability was assessed on a modified EQ-5D+ (EuroQol) description system, 4D3L (4 dimensions and 3 levels) for each FI. The average score of each FI was calculated, divided by 10, and rounded off to determine the weight of each FI type. The scores for the three levels of frequency of each FI were assigned as never = 0 (No episode of FI ever), occasional = 1 (≤ 1 episode of FI/ wk), and common = 2 (> 1 episode of FI/ wk), and was termed as frequency score. The score for each FI would be derived by multiplying the frequency score and the weight for that FI type. In the second phase of the study, a group of colorectal surgeons was asked to rank the six FI types in order of severity, and their ranking was compared with the patient and laypersons' rankings.
RESULTS
Fifty patients and 50 laypersons participated in the study. The weight was assigned to each FI (solid-8, liquid-8, urge-7, flatus-6, mucus-6, and stress-5), and an new scoring system was formulated. The maximum possible score was 80 (total incontinence), and the least 0 (no incontinence). The surgeons' ranking of FI severity did not correlate well with patients' and laypersons' rankings of FI, highlighting that surgeons and patients may perceive the severity of FI differently.
CONCLUSION
A new scoring system for FI was formulated, which was simple, logical, comprehensive, and easy to use, and eliminated previous shortcomings. Patients' and surgeons' perceptions of FI severity of FI did not correlate well.
背景
有几种评分系统用于评估粪便失禁（FI），其中最常用的是 Wexner 和 Vaizey 的评分系统。然而，这些评分系统存在明显的缺陷，因此既不准确也不全面。
目的
开发一种新的 FI 评分系统，使其准确、全面且易于使用。
方法
制定了一个表格，其中包括六种 FI：固体、液体、气体、粘液、压力和急迫。通过让一组患者和非专业人士对每种 FI 从 0 到 100 分（0-最低，100-最高残疾）进行残疾评分，确定每种 FI 的权重。残疾情况根据改良的 EQ-5D+（EuroQol）描述系统进行评估，对于每种 FI 为 4D3L（4 个维度和 3 个级别）。计算每种 FI 的平均得分，除以 10，四舍五入得到每种 FI 类型的权重。为每种 FI 的频率的三个级别分配的分数为：从不=0（从未发生过 FI 发作），偶尔=1（每周≤1 次 FI 发作），经常=2（每周＞1 次 FI 发作），并称为频率得分。每个 FI 的得分将通过乘以频率得分和该 FI 类型的权重来得出。在研究的第二阶段，一组结直肠外科医生被要求按严重程度对六种 FI 类型进行排序，并将他们的排序与患者和非专业人士的排序进行比较。
结果
50 名患者和 50 名非专业人士参与了这项研究。为每种 FI（固体-8、液体-8、急迫-7、气体-6、粘液-6 和压力-5）分配了权重，并制定了一个新的评分系统。最大可能得分为 80 分（完全失禁），最低为 0 分（无失禁）。外科医生对 FI 严重程度的排序与患者和非专业人士对 FI 的排序相关性不佳，这表明外科医生和患者对 FI 的严重程度可能有不同的看法。
结论
制定了一种新的 FI 评分系统，该系统简单、逻辑、全面且易于使用，并消除了以前的缺陷。患者和外科医生对 FI 严重程度的感知相关性不佳。
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