Validation of the Saint Paul's Endoscopy Comfort Scale (SPECS) for upper gastrointestinal endoscopy

Patient comfort is an important predictor of patient satisfaction and a quality indicator in endoscopy. The St. Paul's Endoscopy Comfort Score (SPECS), previously validated for colonoscopy, was assessed for measuring patient comfort during esophagogastroduodenoscopy (EGD).

In this prospective cohort study, 3 groups of assessors (gastroenterologists, nurses, and observers) used SPECS and the modified Gloucester Comfort Scale (GS) to measure patients' comfort during outpatient EGD. Patient-reported outcomes were measured using a visual analogue scale (VAS) and satisfaction survey. Descriptive statistics and inter-rater reliability were calculated across the 3 groups for both tools. The correlation between SPECS, GS, and VAS was calculated.

Three hundred subjects were included. The mean age was 56.7 years (SD 14.7 years) and 160 (53.3%) were male. Overall, 89.0% (N=267) of subjects received conscious sedation with intravenous midazolam and fentanyl at a mean dose of 3.3 mg (SD 1.6 mg) and 51.4 mcg (SD 29.7 mcg), respectively. The mean total SPECS for physicians, nurses, and observers were 1.3 (SD 1.6), 1.4 (SD 1.7), and 1.7 (SD 1.9), respectively. Amongst the 3 assessors (9 physicians, 5 nurses, and 4 observers), SPECS and GS demonstrated good inter-rater reliability with an intraclass coefficient of 0.71 (95% CI, 0.66-0.76) and 0.64 (95% CI, 0.58-0.69), respectively. SPECS and GS had a mild correlation with VAS.

SPECS is a reliable assessment tool to measure patient comfort during EGD. SPECS may be used to audit patient comfort at a facility and physician level.