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The Modified Bristol Stool Form Scale: A Reliable and Valid Tool to Score Stool Consistency in Dutch
Carrie A M Wegh1,2, Gerben D A Hermes1, Margriet H C Schoterman3
1Laboratory of Microbiology, Wageningen University & Research, Wageningen.
Insights
The modified Bristol Stool Form Scale (m-BSFS) is a reliable and valid tool for assessing toddler stool consistency. Parents, grandparents, and childcare workers can effectively use the m-BSFS for both toilet-trained and non-toilet-trained children.
Area of Science:
- Pediatrics
- Gastroenterology
Background:
- Assessing stool consistency in toddlers is crucial for identifying gastrointestinal issues.
- The modified Bristol Stool Form Scale (m-BSFS) is a visual tool used to categorize stool types.
- Evaluating the reliability and validity of the m-BSFS in a Dutch context for toddlers is important.
Purpose of the Study:
- To assess the reliability, validity, and user-friendliness of the modified Bristol Stool Form Scale (m-BSFS) for evaluating stool consistency in toddlers.
- To determine if parents, grandparents, and childcare employees can effectively use the m-BSFS for both toilet-trained and non-toilet-trained toddlers in the Netherlands.
Main Methods:
- The m-BSFS was translated into Dutch and administered to parents, grandparents, and childcare employees evaluating stool pictures of toddlers aged 1-3 years.
- Inter-rater and intra-rater reliability were assessed using intraclass correlation coefficient (ICC) and Cohen kappa (κ) statistics.
- A subgroup also evaluated stool pictures in diapers to validate the scale for non-toilet-trained toddlers.
Main Results:
- The m-BSFS demonstrated high inter-rater and intra-rater reliability, exceeding minimal standards (ICC > 0.61).
- ICC for general stool pictures ranged from 0.71 to 0.79, with Cohen kappa at 0.71.
- ICC for stool pictures in diapers was 0.93, with Cohen kappa at 0.77, indicating strong agreement.
Conclusions:
- The Dutch version of the m-BSFS is a reliable, valid, and user-friendly tool for assessing stool consistency in toddlers.
- The scale is suitable for use by parents, grandparents, and childcare workers in the Netherlands.
- The m-BSFS can be effectively used for both toilet-trained and non-toilet-trained toddlers.
Objective:
The aim of the study was to assess whether the modified Bristol Stool Form Scale (m-BSFS) is reliable, valid and user-friendly to use by parents, grandparents, and day childcare employees to evaluate stool consistency in toilet and nontoilet-trained toddlers in the Netherlands.
Study Design:
Translation to Dutch and validity of the m-BSFS (scoring 32 general stool pictures) for 1 to 3 year old toddlers (n = 89) was evaluated by parents, grandparents, and day childcare employees. A subgroup of participants scored an additional 7 pictures of stools in a diaper to validate the m-BSFS for non-toilet-trained toddlers (n = 16). To determine inter-rater reliability, 2-way random effects single-rater intraclass correlation coefficient (ICC)consistency was used. Intra-rater reliability was measured by Cohen kappa (κ) by rating the same pictures in random order twice, with at least 1 week between the first and second scoring.
Results:
Inter- and intra-rater reliability of the m-BSFS were above recommended minimal standards of 0.61 for the 32 general stool pictures as well as for the 7 pictures of stools in a diaper. ICCconsistency for the general stool pictures of the first and second ratings were 0.71 (n = 89) and 0.79 (n = 77), respectively, with a κ of 0.71 (n = 77). ICCconsistency for the stools in diaper pictures of the first and second ratings were 0.93 (n = 16) and 0.93 (n = 15), respectively, with a κ of 0.77 (n = 15).
Conclusions:
The m-BSFS is reliable, valid and user-friendly to use by Dutch-speaking parents, grandparents, and day childcare workers to evaluate stool consistency in both toilet- and nontoilet-trained toddlers in the Netherlands.
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