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The Brussels Infant and Toddler Stool Scale (BITSS) reliably assesses stool consistency in young children. This scale offers good agreement with the Bristol Stool Form Scale (BSFS) for infants and toddlers.

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Area of Science:

  • Pediatrics
  • Gastroenterology
  • Clinical Assessment

Background:

  • The Bristol Stool Form Scale (BSFS) is not suitable for assessing stool consistency in non-toilet trained children.
  • The Brussels Infant and Toddler Stool Scale (BITSS) was developed using photographs of infant and toddler stools in diapers.

Purpose of the Study:

  • To evaluate the interobserver reliability of stool consistency assessment using the BITSS among parents, nurses, and medical doctors (MDs).

Main Methods:

  • A multicenter cross-sectional study involving 2462 observers (parents, nurses, MDs) from 2016-2017.
  • Observers rated BITSS photographs based on the BSFS criteria.
  • Reliability was assessed using the proportion of perfect agreement and linearly weighted kappa (κ) statistic.

Main Results:

  • The BITSS photographs corresponding to BSFS types 7 and 4 showed the highest agreement (87.5% and 87.6%).
  • Overall weighted kappa (κ) was 0.72, indicating good agreement.
  • A new categorization system (hard, formed, loose, watery stools) demonstrated correct allocation ranging from 83% to 96%.

Conclusions:

  • The BITSS demonstrates good agreement with the BSFS.
  • The BITSS, with its newly categorized photographs, is a reliable tool for assessing stool consistency in non-toilet trained children in clinical practice and research.
  • A multilanguage version of the BITSS is available for download.