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Development of the Brussels Infant and Toddler Stool Scale ('BITSS'): protocol of the study
Yvan Vandenplas1, Hania Szajewska2, Marc Benninga3
1Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Insights
A new scale, the Brussels Infant and Toddler Stool Scale (BITSS), is developed for assessing infant stool consistency. This scale aims to improve objective stool assessment in infants and toddlers, addressing limitations of the adult Bristol Stool Form Scale.
Area of Science:
- Pediatric Gastroenterology
- Clinical Assessment Tools
- Infant Health
Background:
- The Bristol Stool Form Scale (BSS) is used for stool consistency assessment in adults.
- The BSS is often inadequately applied to infants and toddlers wearing diapers.
- A specialized scale is needed for accurate stool assessment in young children.
Purpose of the Study:
- To develop the Brussels Infant and Toddler Stool Scale (BITSS).
- To evaluate the interobserver agreement of stool assessment using BITSS.
- To compare agreement between parents and healthcare providers (physicians, nurses).
Main Methods:
- Phase I: Selection of stool photographs for infants/toddlers by pediatric gastroenterology key-opinion leaders.
- Development of the BITSS by replacing BSS drawings with selected infant/toddler stool photographs.
- Phase II: Assessment of interobserver variability in BITSS interpretation.
Main Results:
- The study aims to demonstrate high consensus in BITSS interpretation among parents and healthcare providers.
- The study seeks to confirm agreement is independent of observer type (parent vs. healthcare provider).
- Interobserver variability will be quantified.
Conclusions:
- The BITSS is designed to provide an objective stool consistency assessment for infants and toddlers.
- The scale aims to improve diagnostic accuracy in pediatric gastroenterology.
- High interobserver agreement is anticipated, facilitating clinical utility.
Introduction:
The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale ('BITSS'), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient's parent and healthcare providers (physicians and nurses).
Methods And Analysis:
This study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient's parent and healthcare providers will be assessed.
Ethics And Dissemination:
The study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences.
Trial Registration Number:
NCT02913950.