Using Barthel Index and Performance Status Scale to Predict Inpatient Bowel Preparation Quality
Repository Posting Date2017-07-03T17:38:57Z
Author DetailsYu-Chi Kuo, BSN, RN; Ming-Wun Wong; Ning-Hsin Lee; Tzu-an Hsu; Wei-Chen Lin; Chun-han Cheng
Lead Author Sigma AffliationNon-member
Level of EvidenceN/A
KeywordsBarthel Index; Bowel Preparation; Performance Status Scale by Eastern Cooperative Oncology Group
Bowel preparation, cecal intubation rate, and adenoma detection rate influence the quality of colonoscopy and interval cancer rate. Adequate bowel preparation is first and essential step for not only procedure safety but also lesions defection ability. According to literature, several factors affect inpatient bowel preparation such as age, socioeconomic class, opiate/ tricyclic antidepressants use, and physical status classification system by American society of anesthesiologists. However, there was still lack of general predicting model. Under hypothesis that patient’s activity may be related to bowel movement then influence the bowel preparation. Thus we tried to predict inpatient bowel preparation by activity scoring system: Barthel index and performance status scale by eastern cooperative oncology group that routinely assessed in our inpatient nursing work. This study was aimed to evaluate predicting power of Barthel index and performance status scale by eastern cooperative oncology group for inpatient bowel preparation. We also investigated the cutoff values of scoring systems for inadequate bowel preparation.
All consecutive patients hospitalized for colonoscopy at the gastroenterology ward between 2016 May to 2016 June were retrospectively analyzed. We used Aronchick scale for bowel preparation evaluation. The level “excellent” and “good” were defined as adequate; “fair” and “poor” were defined as inadequate. All patients’ activity statuses were assessed by Barthel index and performance status scale by eastern cooperative oncology group. The results were tested by receiver operating characteristic curve. Final the cutoffs were calculated by Youden's index.
During the period of study, 100 hospitalized patients were retrospectively reviewed. The adequate bowel preparation rate was 70%. In addition, adenoma detection rate was 35%; cecal intubation rate was 99%. In receiver operating characteristic curve, area under curve of Barthel index was 0.798; area under curve of performance status scale by eastern cooperative oncology group was 0.824. Both of them were good discrimination for bowel preparation. After Youden's index calculation, we found 82 was cutoff for Barthel index and 1 was for performance status scale by eastern cooperative oncology group.
Both Barthel index and performance status scale by eastern cooperative oncology group were valuable to predicting inpatient bowel preparation. In daily practice, cutoffs let medical team pay more attention to possible inadequate bowel preparation.