title: Risk factors for inadequate bowel preparation: a validated predictive score.
abstract: Background and study aimInadequate bowel cleansing negatively affects the efficiency of colonoscopy in routine clinical practice. The aim of this study was to design and validate a predictive model for inadequate bowel cleanliness.Patients and methodsThe model was built from 667 consecutive outpatients (development cohort) who were prospectively scheduled for colonoscopy between June and September 2014. The validation cohort included 409 outpatients who underwent colonoscopy between October and December 2014. Cleansing was evaluated using the Boston Bowel Preparation Scale (BBPS). Bowel preparation was administered on the same day as the examination.ResultsIn the development cohort, BBPS was adequate in 541 patients (81.1 %). At multivariate analysis, antidepressants (odds ratio [OR] 4.25, 95 % confidence interval [CI] 1.91 - 9.47), co-morbidity (OR 3.35, 95 %CI 2.16 - 5.18), constipation (OR 2.09, 95 %CI 1.29 - 3.40), and abdominal/pelvic surgery (OR 1.60, 95 %CI 1.03 - 2.47) were independent predictors for inadequate cleansing. The model built with these variables showed an area under the curve of 0.72 in the development cohort and 0.70 in the validation cohort. A cutoff of 1.225 predicted inadequate bowel preparation with a sensitivity, specificity, positive predictive value, and negative predictive value of 60.3 % (95 %CI 51.6 - 68.4), 75.4 % (95 %CI 71.6 - 78.9), 36.4 % (95 %CI 30.1 - 43.1), and 89.1 % (95 %CI 85.9 - 91.6) in the development cohort, and 50.0 % (95 %CI 38.1 - 61.9), 80.0 % (95 %CI 75.3 - 84.2), 35.7 % (95 %CI 26.4 - 45.6), and 87.9 % (95 %CI 83.7 - 91.3) in the validation cohort.ConclusionA simple score may assist the clinician in predicting which patients are at high risk of inadequate bowel cleanliness. This may guide changes in bowel preparation strategy accordingly.
authors.forename: Antonio Z
authors.initials: AZ
authors.lastname: Gimeno-García
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Baute
authors.forename: Goretti
authors.initials: G
authors.lastname: Hernandez
authors.forename: Dalia
authors.initials: D
authors.lastname: Morales
authors.forename: Carmen Delia
authors.initials: CD
authors.lastname: Gonzalez-Pérez
authors.forename: David
authors.initials: D
authors.lastname: Nicolás-Pérez
authors.forename: Onofre
authors.initials: O
authors.lastname: Alarcon-Fernández
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.forename: Manuel
authors.initials: M
authors.lastname: Hernandez-Guerra
authors.forename: Rafael
authors.initials: R
authors.lastname: Romero
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Alonso
authors.forename: Yanira
authors.initials: Y
authors.lastname: Gonzalez
authors.forename: Zaida
authors.initials: Z
authors.lastname: Adrian
authors.forename: Marta
authors.initials: M
authors.lastname: Carrillo
authors.forename: Laura
authors.initials: L
authors.lastname: Ramos
authors.forename: Enrique
authors.initials: E
authors.lastname: Quintero
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D002400:Cathartics / Q000627:therapeutic use; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D015897:Comorbidity; D003248:Constipation / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D000928:Antidepressive Agents; D002400:Cathartics