Comparison of the Bristol Stool Scale and Modified Version for Children: Use by Providers vs Children

Area of Science:

• Pediatric Gastroenterology
• Clinical Assessment Tools
• Child Health Research

Background:

• Accurate stool form reporting is crucial for diagnosing pediatric gastrointestinal conditions and monitoring treatment efficacy.
• The modified Bristol Stool Form Scale for Children (mBSFS-C), a 5-type scale, is established as reliable and valid.
• A direct comparison between the mBSFS-C and the traditional 7-type Bristol Stool Form Scale (BSFS) regarding provider and child ratings was lacking.

Purpose of the Study:

• To directly compare the agreement of provider and child ratings using the mBSFS-C versus the traditional BSFS.
• To evaluate the concordance between pediatric providers and children when assessing stool form with both scales.

Main Methods:

• Pediatric gastroenterology providers and 200 children (mean age 12 years) rated 35 diverse stool photographs using both the mBSFS-C and BSFS.
• Photograph presentation and scale order were randomized to mitigate bias.
• Modal ratings were calculated for each scale and participant group, with agreement percentages determined.

Main Results:

• The mBSFS-C demonstrated higher modal agreement among providers (90.0%) and children (84.6%) compared to the BSFS (77.8% for providers, 71.8% for children).
• Provider-child concordance for stool photograph ratings was higher with the mBSFS-C (35/35 matched) than with the BSFS (30/35 matched).
• No order effect was observed for scale presentation.

Conclusions:

• The mBSFS-C exhibits superior modal agreement among both pediatric providers and children compared to the traditional BSFS.
• Provider-child concordance in assessing stool form is enhanced when using the mBSFS-C.
• Further validation of the mBSFS-C in diverse populations and regions is recommended.