Prospective comparison of faecal incontinence grading systems

Background-Existing scales for assessing faecal incontinence have not been validated against clinical assessment, or with regard to reproducibility. T hey also fail to take into account faecal urgency, and the use of antidiarr hoeal medications. Aims-To establish the validity, and sensitivity to change, of existing scal es and a newly designed incontinence scale. Methods-(1) Twenty three patients (21 females, median age 57 years) were pr ospectively evaluated by two independent clinical observers, using three es tablished scales (Pescatori, Wexner, American ECarapeti Medical Systems), a newly devised scale which also includes details about urgency and antidiar rhoeal drugs, and by a 28 day diary. (2) A further 10 female patients were assessed by the same scales before and after surgery for faecal incontinenc e. Results-(1) Assessments by two independent clinicians correlated well. All four scales and a diary card correlated highly and significantly with the c linical impression, with the new scale reaching the highest correlation (r= 0.79, p<0.001). (2) All except one score changed significantly in response to surgical treatment; the new scale showed the greatest change, at the hig hest level of significance (p=0.004), and correlated best with the clinicia ns' assessment of change (r=0.94, p<0.001). Conclusions-Existing scales for the assessment of faecal incontinence corre late well with careful clinical impression of severity, and serve as useful and reproducible measures for comparison of patients and treatments. A new ly devised scale has shown high clinical validity and utility.