Elsevier

The Journal of Pediatrics

Volume 159, Issue 3, September 2011, Pages 437-441.e1
The Journal of Pediatrics

Original Article
Reliability and Validity of a Modified Bristol Stool Form Scale for Children

https://doi.org/10.1016/j.jpeds.2011.03.002Get rights and content

Objectives

This study sought to: evaluate the ability of children to reliably use a modified Bristol Stool Form Scale for Children (mBSFS-C), evaluate criterion-related validity of the mBSFS-C, and identify the lower age limit for mBSFS-C use.

Study design

The mBSFS-C comprises 5 stool form types described and depicted in drawings. Children 3 to 18 years old rated stool form for 10 stool photographs. Because of low reliability when stool form descriptors were not read aloud (n = 119), a subsequent sample of children (n = 191) rated photographs with descriptors read.

Results

Intraclass correlation coefficients for descriptor-unread versus -read samples were 0.62 and 0.79, respectively. Children were increasingly reliable with age. Percentage of correct ratings varied with stool form type, but generally increased with age. With descriptors unread, children 8 years and older demonstrated acceptable interobserver reliability, with >78% of ratings correct. With descriptors read, children 6 years and older demonstrated acceptable reliability, with >80% of ratings correct.

Conclusions

The mBSFS-C is reliable and valid for use by children, with age 6 years being the lower limit for scale use with descriptors read and age 8 years being the lower limit without descriptors read. We anticipate that the mBSFS-C can be effectively used in pediatric clinical and research settings.

Section snippets

Methods

As described previously, the original BSFS was adapted by decreasing the number of stool categories from 7 to 5.18 This reduces the discriminations children are required to make, with the goal of maintaining scale usefulness while increasing accuracy of classification by young children who may have more difficulty attending to and discriminating between the original 7 categories. Reducing response categories for self-report scale use by children is common practice.19, 20, 21

The 5 categories

Inter-Observer Reliability with Unread Stool Form Descriptors

When stool form descriptors were not read to the children (n = 119; 48.7% female), the single measures intra-class correlation coefficient for the total sample was 0.62 (95% CI, 0.44 to 0.85; P < .001). Inter-observer reliability did not reach acceptable standards (ie, >0.70) until the children were 8 to 10 years of age, with the youngest children evidencing extremely low reliability (Table II). As previously mentioned, this led us to evaluate reliability and validity of the mBSFS-C in a second

Discussion

Despite the usefulness of assessing stool form in clinical practice and research, few have attempted to validate stool form scales, and such a scale has not been validated for use in children. We present the mBSFS-C as a stool form rating scale with pictorial representations and short descriptors that requires fewer discriminations than the standard BSFS, while still capturing clinically relevant differentiations. We anticipate that the mBSFS-C can be effectively used in clinical and research

References (22)

  • G.F. Longstreth et al.

    Functional bowel disorders

    Gastroenterology

    (2006)
  • A. Rasquin et al.

    Childhood functional gastrointestinal disorders: child/adolescent

    Gastroenterology

    (2006)
  • B.P. Chumpitazi et al.

    Creation and initial evaluation of a stool form scale for children

    J Pediatr

    (2010)
  • L.J.D. O’Donnell et al.

    Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate

    BMJ

    (1990)
  • C.J. Probert et al.

    Intestinal transit time in the population calculated from self made observations of defecation

    J Epidemiol Community Health

    (1993)
  • K.W. Heaton et al.

    An office guide to whole-gut transit time: patients recollection of their stool form

    J Clin Gastroenerol

    (1994)
  • L.P. Degen et al.

    How well does tool form reflect colonic transit?

    Gut

    (1996)
  • S.J. Lewis et al.

    Stool form scale as a useful guide to intestinal transit time

    Scand J Gastroenterol

    (1997)
  • R.J. Saad et al.

    Do stool form and frequency correlate with whole-gut colonic transit? Results from a multicenter study in constipated individuals and healthy controls

    Am J Gastroenterol

    (2010)
  • K.W. Heaton et al.

    Defecation frequency and timing, and stool form in the general population: a prospective study

    Gut

    (1992)
  • J. Tinmouth et al.

    Evaluation of stool frequency and stool form as measures of HIV-related diarrhea

    HIV Clin Trials

    (2007)
  • Cited by (112)

    View all citing articles on Scopus

    Supported by an investigator-initiated grant from Takeda Pharmaceuticals. Funding was independent of: (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication. Salary support to one or more of the authors during the conduct of this study has been provided by the National Institutes of Health (R01 NR05337, UH2 DK083990, and RC2 NR011959), the Daffy’s Foundation, and the USDA/ARS (under Cooperative Agreement 6250-51000-043 and P30 DK56338), which funds the Texas Medical Center Digestive Disease Center. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The contents do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. The authors declare no conflicts of interest.

    View full text