• Koen Huysentruyt
  • Ilan Koppen
  • Marc Benninga
  • Tom Cattaert
  • Jiqiu Cheng
  • Charlotte De Geyter
  • Faure Christophe
  • Frédéric Gottrand
  • Badriul Hegar
  • Iva Hojsak
  • Mohamad Miqdady
  • Seksit Osatakul
  • Carmen Ribes-Koninckx
  • Silvia Salvatore
  • Miguel Saps
  • Raanan Shamir
  • Annamaria Staiano
  • Hania Szajewska
  • Mario Vieira
  • Yvan Vandenplas
  • and the BITSS working group

OBJECTIVES: The Bristol Stool Form Scale (BSFS) is inadequate for non-toilet trained children. The Brussels Infant and Toddler Stool Scale (BITSS) was developed, consisting of 7 photographs of diapers containing stools of infants and toddlers. We aimed to evaluate inter-observer reliability of stool consistency assessment among parents, nurses and medical doctors (MDs) using the BITSS.

METHODS: In this multicenter cross-sectional study (2016-2017), BITSS photographs were rated according to the BSFS. The reliability of the BITSS was evaluated using the overall proportion of perfect agreement and the linearly weighted κ statistic.

RESULTS: A total of 2,462 observers participated: 1,181 parents (48.0%), 624 nurses (25.3%) and 657 MDs (26.7%). The best-performing BITSS photographs corresponded with BSFS type 7 (87.5%) and type 4 (87.6%), followed by the BITSS photographs representing BSFS type 6 (75.0%), BSFS type 5 (68.0%), BSFS type 1 (64.8%), and BSFS type 3 (64.6%). The weakest performing BITSS photograph corresponded with BSFS type 2 (49.7%). The overall weighted κ-value was 0.72 (95% CI 0.59-0.85; good agreement). Based on these results, photographs were categorized per stool group as hard (BSFS type 1-3), formed (BSFS type 4), loose (BSFS types 5&6) or watery (BSFS type 7) stools. According to this new categorization system, correct allocation for each photograph ranged from 83-96% (average: 90%).The overall proportion of correct allocations was 72.8%.

CONCLUSIONS: BITSS showed good agreement with BSFS. Using the newly categorized BITSS photographs, the BITSS is reliable for the assessment of stools of non-toilet trained children in clinical practice and research. A multi-language translated version of the BITSS can be downloaded at https://bitss-stoolscale.com/.

Original languageEnglish
Pages (from-to)207-213
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number2
Early online date20 Sep 2018
Publication statusPublished - 1 Feb 2019

    Research areas

  • Journal Article

ID: 39976357