title: Predicting inadequate bowel preparation for colonoscopy in participants receiving split-dose bowel preparation: development and validation of a prediction score.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  Four centers, including one academic and three medium-to-large size nonacademic centers.
  
  
  METHODS
  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%).
  
  
  METHODS
  Colonoscopy.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Study design partially retrospective, no data on patient compliance.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Vincent K
authors.initials: VK
authors.lastname: Dik
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Leon M G
authors.initials: LM
authors.lastname: Moons
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Melek
authors.initials: M
authors.lastname: Hüyük
authors.affiliation: Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Schaar
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Wouter H
authors.initials: WH
authors.lastname: de Vos Tot Nederveen Cappel
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Pieter C J
authors.initials: PC
authors.lastname: Ter Borg
authors.affiliation: Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Maarten A C
authors.initials: MA
authors.lastname: Meijssen
authors.affiliation: Department of Gastroenterology and Hepatology, Ikazia Hospital, Rotterdam, The Netherlands.
authors.forename: Rob J T H
authors.initials: RJ
authors.lastname: Ouwendijk
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Doris M
authors.initials: DM
authors.lastname: Le Fèvre
authors.affiliation: Gupta Strategists, Ophemert, The Netherlands.
authors.forename: Merijn
authors.initials: M
authors.lastname: Stouten
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Onno
authors.initials: O
authors.lastname: van der Galiën
authors.affiliation: Achmea Health Care, Leiden, The Netherlands.
authors.forename: Theo J
authors.initials: TJ
authors.lastname: Hiemstra
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Monkelbaan
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martijn G H
authors.initials: MG
authors.lastname: van Oijen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000008:administration & dosage*; D002951:Citrates / Q000008:administration & dosage*; D019343:Citric Acid / Q000008:administration & dosage*; D003113:Colonoscopy; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009942:Organometallic Compounds / Q000008:administration & dosage*; D010847:Picolines / Q000008:administration & dosage*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010847:Picolines; D019343:Citric Acid; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C110422:magnesium citrate