Vaizey C J, Carapeti E, Cahill J A, Kamm M A
The Middlesex Hospital, Mortimer Street, London W1N 8AA, UK.
Gut. 1999 Jan;44(1):77-80. doi: 10.1136/gut.44.1.77.
Existing scales for assessing faecal incontinence have not been validated against clinical assessment, or with regard to reproducibility. They also fail to take into account faecal urgency, and the use of antidiarrhoeal medications.
To establish the validity, and sensitivity to change, of existing scales and a newly designed incontinence scale.
(1) Twenty three patients (21 females, median age 57 years) were prospectively evaluated by two independent clinical observers, using three established scales (Pescatori, Wexner, American Medical Systems), a newly devised scale which also includes details about urgency and antidiarrhoeal drugs, and by a 28 day diary. (2) A further 10 female patients were assessed by the same scales before and after surgery for faecal incontinence.
(1) Assessments by two independent clinicians correlated well. All four scales and a diary card correlated highly and significantly with the clinical impression, with the new scale reaching the highest correlation (r=0.79, p<0.001). (2) All except one score changed significantly in response to surgical treatment; the new scale showed the greatest change, at the highest level of significance (p=0.004), and correlated best with the clinicians' assessment of change (r=0.94, p<0.001).
Existing scales for the assessment of faecal incontinence correlate well with careful clinical impression of severity, and serve as useful and reproducible measures for comparison of patients and treatments. A newly devised scale has shown high clinical validity and utility.
现有的评估大便失禁的量表尚未经过与临床评估的对比验证，也未评估其可重复性。这些量表还未考虑大便急迫感以及止泻药物的使用情况。
确定现有量表以及新设计的失禁量表的有效性和对变化的敏感性。
（1）23名患者（21名女性，中位年龄57岁）由两名独立的临床观察者进行前瞻性评估，使用三种已确立的量表（佩斯卡托里量表、韦克斯纳量表、美国医疗系统量表）、一种新设计的量表（该量表还包括有关急迫感和止泻药物的详细信息）以及一份为期28天的日记。（2）另外10名女性患者在大便失禁手术前后接受相同量表的评估。
（1）两名独立临床医生的评估相关性良好。所有四种量表和一张日记卡与临床印象高度且显著相关，新量表的相关性最高（r = 0.79，p < 0.001）。（2）除一项评分外，所有评分在手术治疗后均有显著变化；新量表变化最大，具有最高的显著性水平（p = 0.004），并且与临床医生对变化的评估相关性最佳（r = 0.94，p < 0.001）。
现有的大便失禁评估量表与对严重程度的仔细临床印象相关性良好，可作为比较患者和治疗方法的有用且可重复的指标。一种新设计的量表已显示出较高的临床有效性和实用性。
