Health-related quality of life (HRQOL) measurement has emerged as an important health outcome in clinical trials, clinical practice improvement strategies, and healthcare services research and evaluation. HRQOL measures are also increasingly proposed for use in clinical practice settings to inform treatment decisions. In settings where HRQOL measures have been utilized with adults, physicians report such measures as useful, some physicians alter their treatment based on patient reports on such instruments, and patients themselves generally feel the instruments to be helpful. However, there is a dearth of studies evaluating the clinical utility of HRQOL measurement in pediatric clinical practice. This paper provides an updated review of the literature and proposes a precept governing the application of pediatric HRQOL measurement in pediatric clinical practice. Utilizing HRQOL measurement in pediatric healthcare settings can facilitate patient-physician communication, improve patient/parent satisfaction, identify hidden morbidities, and assist in clinical decision-making. Demonstrating the utility of pediatric HRQOL measurement in identifying children with the greatest needs, while simultaneously demonstrating the cost advantages of providing timely, targeted interventions to address those needs, may ultimately provide the driving force for incorporating HRQOL measurement in pediatric clinical practice.

The primary aim of the study was to investigate the generic health-related quality of life (HRQOL) of pediatric patients meeting Rome II criteria for irritable bowel syndrome (IBS) in comparison to healthy children. The secondary aim was to compare pediatric patients with IBS to pediatric patients with Rome II criteria diagnosed functional abdominal pain (FAP) and patients with diagnosed organic gastrointestinal (GI) disorders. The study also investigated the associations between GI symptoms with generic HRQOL and evaluated group differences in school days missed and days sick in bed and needing care. HRQOL was measured with the PedsQLtrade mark 4.0 Generic Core Scales (Physical, Emotional, Social, and School Functioning). The PedsQLtrade mark was administered in outpatient pediatric gastroenterology clinics in California, Texas, and New Jersey. A total of 287 families (280 child self-report, 286 parent proxy-report) with children diagnosed with IBS (n = 123), FAP (n = 82), or organic GI disorders (n = 82) participated. Pediatric patients with IBS demonstrated significantly lower Physical, Emotional, Social, and School Functioning in comparison to healthy children, and comparable HRQOL to patients with FAP and organic GI diagnoses. GI symptoms were significantly associated with generic HRQOL. Patients with IBS demonstrated a significantly greater number of days missed from school, days sick in bed/too ill to play, and days needing someone to care for them than healthy children, but significantly fewer days than patients with FAP and organic GI disorders. Pediatric patients with IBS demonstrated impaired HRQOL in dimensions measuring Physical, Emotional, Social, and School Functioning. These findings suggest the need for targeted interventions to address these dimensions of impaired HRQOL.

Objectives This study sought to: 1) evaluate the ability of children to reliably use a modified Bristol Stool Form Scale for Children (mBSFS-C), 2) evaluate criterion-related validity of the mBSFS-C, and 3) identify the lower age limit for mBSFS-C use. Study design The mBSFS-C comprises five stool form types described and depicted in drawings. Children 3–18 years rated stool form for ten stool photographs. Due to low reliability when stool form descriptors were not read aloud (n=119), a subsequent sample (n=191) rated photographs with descriptors read. Results Intraclass correlation coefficients for descriptor-unread versus -read samples were 0.62 and 0.79. Children were increasingly reliable with age. Percentage of correct ratings varied by stool form type but generally increased with age. With descriptors unread, children 8 years and older demonstrated acceptable inter-observer reliability with over 78% of ratings correct. With descriptors read, children 6 years and older demonstrated acceptable reliability and over 80% of ratings correct. Conclusions The mBSFS-C is reliable and valid for use by children, age 6 being the lower limit for scale use with descriptors read and age 8 without descriptors read. We anticipate that the mBSFS-C can be effectively used in pediatric clinical and research settings.

Objective-To develop a pediatric stool form rating scale and determine its inter-rater reliability, intra-rater reliability, and agreement amongst pediatric gastroenterologists.Study design-An ordinal stool scale with five categorical stool form types was created based on the Bristol Stool Form Scale (BSFS), and 32 color two-dimensional stool photographs were shown to 14 pediatric gastroenterologists. Each gastroenterologist rated the stool form depicted in each photograph using the modified stool scale. Ten gastroenterologists agreed to re-rate the stool form depicted in each photograph a minimum of six months after the first rating.Results-448 ratings were completed; 430 (94%) of all ratings were within at least one category type of the most common (modal) rating for each photograph. Eight (25%) stool photographs had complete agreement amongst all raters. Inter-rater and intra-rater reliability was high with a single measure intraclass correlation of 0.85 (95% CI: 0.78-0.91; P<0.001) and 0.87 (95% CI: 0.81-0.92; P<0.001) respectively.Conclusion-A modified pediatric BSFS provided a high degree of inter-rater reliability, intrarater reliability, and agreement amongst pediatric gastroenterologists.Alterations in stool form and frequency are associated with numerous gastrointestinal disorders ranging from inflammatory disorders (e.g. ulcerative colitis) to functional gastrointestinal disorders (e.g. irritable bowel syndrome). Diagnostic criteria for gastrointestinal disorders may depend, in part, on whether changes in stool form are associated with symptoms 1 . Stool form may also guide assessment of treatment efficacy or determine the clinical status of a disorder. Therefore, assessment of stool form may aide clinicians in diagnosis and management of underlying gastrointestinal disorders, and may serve as a measurable clinical outcome employed in the clinical research setting 2 , 3.© 2010 Mosby, Inc. All rights reserved.Correspondence/Reprint Request Contact: Bruno Chumpitazi, M.D., M.P.H., Texas Children's Hospital, 6701 Fannin Street, CCC 1010.00, Houston, TX 77030, bpchumpi@texaschildrens.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. An often used measure of stool form is the Bristol Stool Form Scale (BSFS) 4 . This scale allows one to classify stool form into seven types ranging from "separate hard lumps like nuts" (type 1) to "watery, no solid pieces, entirely liquid" (type 7) 5. However, the BSFS was validated in adults as a measure of stool transit rather than as a means of identifying stool form 4. Despite this fact, it has been used to evaluate stoo...