In vivo assessment by parents and a physician using the Amsterdam Infant Stool Scale provided better inter-rater agreement than photographic evaluation.
OBJECTIVE
This study assessed the inter-rater variability of stool assessment, comparing the judgement of parents and a physician using the Amsterdam Infant Stool Scale (AISS) and the evaluation by another physician using photographs.


METHODS
The stools of children aged two to 18 months, who were not toilet-trained, were independently assessed in vivo using the AISS by the parents and the first physician. Another physician, unaware of the results of the in vivo evaluation, assessed two stool photographs taken by the first physician with a smartphone.


RESULTS
Having analysed 100 stools, we found excellent inter-rater agreement between the parents and the first physician for consistency (κ: 0.87; 95% confidence interval [95% CI] 0.78-0.95) and colour (κ: 0.81; 95% CI: 0.71-0.91) and good inter-rater agreement for the amount (κ: 0.79; 95% CI 0.7-0.88). We found moderate inter-rater agreement between the parents' in vivo assessment and the second physician's photographic assessment for stool consistency (κ: 0.5; 95% CI 0.36-0.64) and amount (κ: 0.44; 95% CI 0.29-0.59) and a fair inter-rater agreement for colour (κ: 0.33; 95% CI 0.21-0.45).


CONCLUSIONS
When parents and a physician used the AISS under in vivo conditions, there was better inter-rater agreement than photographic evaluation by a second physician.
Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Katarzyna
K
Wojtyniak
Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Andrea
A
Horvath
Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland.
Piotr
P
Dziechciarz
D019411:Clinical Laboratory Techniques / Q000379:methods; D005243:Feces; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015588:Observer Variation; D010290:Parents; D010781:Photography; D010820:Physicians; D012494:Sampling Studies; D012680:Sensitivity and Specificity
Amsterdam Infant Stool Scale; Gastrointestinal disorders; In vivo assessment; Inter-rater agreement; Stool photographs