Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score

• Published in: Gastrointestinal endoscopy Vol. 81; no. 3; pp. 665 - 672
• Main Authors: Dik, Vincent K., MD, Moons, Leon M.G., MD, PhD, Hüyük, Melek, BSc, van der Schaar, Peter, MD, PhD, de Vos tot Nederveen Cappel, Wouter H., MD, PhD, ter Borg, Pieter C.J., MD, PhD, Meijssen, Maarten A.C., MD, PhD, Ouwendijk, Rob J.T.H., MD, PhD, Le Fèvre, Doris M, Stouten, Merijn, van der Galiën, Onno, Hiemstra, Theo J, Monkelbaan, Jan F., MD, van Oijen, Martijn G.H., PhD, Siersema, Peter D., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2015
• Subjects: Adult; Aged; Aged, 80 and over; Cathartics - administration & dosage; Citrates - administration & dosage; Citric Acid - administration & dosage; Colonoscopy; Decision Support Techniques; Female; Gastroenterology and Hepatology; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Organometallic Compounds - administration & dosage; Picolines - administration & dosage; Polyethylene Glycols - administration & dosage; Prospective Studies; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; positive predictive value; Boston Bowel Preparation Scale; polyethylene glycol; American Society of Anesthesiologists Physical Status Classification System; body mass index; area under the curve; ASA; AUC; NPV; PG; PPV; BBPS; negative predictive value; BMI
• ISSN: 0016-5107; 1097-6779
• DOI: 10.1016/j.gie.2014.09.066

Background Adequate bowel preparation is important for optimal colonoscopy. It is important to identify patients at risk for inadequate bowel preparation because this allows taking precautions in this specific group. Objective To develop a prediction score to identify patients at risk for inadequate bowel preparation who may benefit from an intensified bowel cleansing regimen. Design Patient and colonoscopy data were prospectively collected, whereas clinical data were retrospectively collected for a total of 1996 colonoscopies in participants who received split-dose bowel preparation. Multivariate logistic regression analyses were conducted in a random two-thirds of the cohort to develop a prediction model. Validation and evaluation of the discriminative power of the prediction model were performed within the remaining one-third of the cohort. Setting Four centers, including one academic and three medium-to-large size nonacademic centers. Patients Consecutive colonoscopies in November and December 2012. Mean age was 57.3 ± 15.9 years, 45.8% were male and indications for colonoscopy were screening and/or surveillance (27%), abdominal symptoms and/or blood loss and/or anemia (60%), inflammatory bowel disease (9%), and others (4%). Interventions Colonoscopy. Main Outcome Measurements Inadequate bowel preparation defined as Boston Bowel Preparation Scale score <6. Results A total of 1331 colonoscopies were included in the development cohort, of which 172 (12.9%) had an inadequate bowel preparation. Independent factors included in the prediction model were American Society of Anesthesiologists Physical Status Classification System score ≥3, use of tricyclic antidepressants, use of opioids, diabetes, chronic constipation, history of abdominal and/or pelvic surgery, history of inadequate bowel preparation, and current hospitalization. The discriminative ability of the scale was good, with an area under the curve of 0.77 in the validation cohort. Limitations Study design partially retrospective, no data on patient compliance. Conclusion We developed a validated, easy-to-use prediction scale that can be used to identify subjects with an increased risk of inadequate bowel preparation with good accuracy.