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Paediatrics
Protocol
Development of the Brussels Infant and Toddler Stool Scale (‘BITSS’): protocol of the study
  1. Yvan Vandenplas1,
  2. Hania Szajewska2,
  3. Marc Benninga3,
  4. Carlo Di Lorenzo4,
  5. Christophe Dupont5,
  6. Christophe Faure6,
  7. Mohamed Miqdadi7,
  8. Seksit Osatakul8,
  9. Carmen Ribes-Konickx9,
  10. Miguel Saps4,
  11. Raanan Shamir10,
  12. Annamaria Staiano11
  13. on behalf of the BITSS Study Group
    1. 1Department of Pediatrics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
    2. 2Department of Pediatrics, The Medical University of Warsaw, Warsaw, Poland
    3. 3Department of Pediatrics, Emma Children's Hospital/AMC, Amsterdam, The Netherlands
    4. 4Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, Ohio, USA
    5. 5Department of Pediatric Gastroenterology Hepatology and Nutrition, Hôpital Necker Enfants Malades, Paris, France
    6. 6Pediatric Gastroenterology, Sainte-Justine Hospital, Montreal, Quebec, Canada
    7. 7Sheikh Khalifa Medical City, Abu Dhabi, UAE
    8. 8Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
    9. 9Pediatric Gastroenterology and Hepatology Unit, La Fe University Hospital, Valencia, Spain
    10. 10Schneider Children's Medical Centre of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
    11. 11Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
    1. Correspondence to Dr Yvan Vandenplas; yvan.vandenplas{at}uzbrussel.be

    Abstract

    Introduction The Bristol Stool Form Scale (BSS) which consists of 7 photographs of different stool forms allows assessment of stool consistency (scale 1 for hard lumps to scale 7 for watery stools), in an objective manner in adults. The BSS is also sometimes used to characterise the stools of infants and young children. Despite its use, there is general agreement among paediatric gastroenterologists that the BSS is not adequate to be used in infants and young children who wear diapers; thus, a new scale specifically designed for this population is needed. Our aim is to develop a paediatric stool scale, the Brussels Infant and Toddler Stool Scale (‘BITSS’), and to evaluate the interobserver agreement of stool assessment with the BITSS between the patient's parent and healthcare providers (physicians and nurses).

    Methods and analysis This study has two phases. In the first phase, 11 key-opinion leaders in the field of paediatric gastroenterology representing different areas of the world selected seven coloured photographs of infants and/or young children wearing diapers to match the original descriptors of the BSS. The selected photographs were used to create a new scale in which the drawings of stools of the BSS were replaced by infant/toddlers stool photographs. In phase II, we aim at demonstrating that parents, nurses and primary healthcare physicians interpret the stool-pictures of the BITSS with a high degree of consensus and that the agreement is independent of whether it is a parent or a healthcare provider. Interobserver variability of stool assessment with the BITSS between the patient's parent and healthcare providers will be assessed.

    Ethics and dissemination The study will be approved by the Ethics Committee of the participating centres. The findings of this study will be submitted to a peer-reviewed journal. Abstracts will be submitted to national and international conferences.

    Trial registration number NCT02913950.

    • Bristol stool scale
    • stool
    • defecation

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

    https://doi.org/10.1136/bmjopen-2016-014620

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      Footnotes

      • YV and HS are joint lead authors.

      • Collaborators The Paediatric Bristol Stool Scale Study Group: Johan Franckx (Belgium), Robin Green (South Africa), Badriul Hegar (Indonesia), Roel Lemmens (Belgium), Silvia Salvatore (Italy), Mario Vieira (Brazil), Marc Verghote (Belgium) and Ioannis Xinias (Greece).

      • Contributors YV conceptualised the study. YV and HS developed the first draft of the manuscript and contributed equally. All authors contributed to the development of the study protocol and approved the final draft of the manuscript.

      • Funding The project runs independently from industry, without any funding or financial compensation. All work was and will be carried out ‘freelance’.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.