The aim of this study is to assess interobserver and intraobserver variability of the Amsterdam Stool Scale in clinical practice. After passing a stool by the child participating in the study it will be assessed using the Amsterdam Stool Scale independently by one of the parents and the medical doctor. At the same time a parent will take 2 photos that will be independently evaluated by another doctor.

INTRODUCTION:

Description of stool appearance is important in clinical practice. Parents are often asked to evaluate stool of their child. At present parents also take more frequently photos using smartphone camera when they are concerned with child's stool appearance and show it to their doctors. To make stool evaluation easier there have been stool form scales created. One of this is Amsterdam Stool Scale that enables stool assessment of children who are not yet toilet trained. This scale facilitates to describe amount, consistency and color of the stool.

AIM:

To assess interobserver and intraobserver variability of the Amsterdam Stool Scale in clinical practice.

METHODS:

After passing a stool by the child participating in the study, within a short-time interval (<5 min), the stool will be assessed independently by one of the parents and the medical doctor. At the same time a parent will take 2 photos with phone camera. The photographs then will be independently evaluated by another doctor who will be unaware of both the "in vivo" stool appraisal and child condition.

STATISTICAL ANALYSIS:

Then the interobserver (between a parent, the doctor and the doctor assessing photograph) variability will be evaluated by calculating the kappa (κ) statistics for nominal data for the stool consistency, amount and color separately.

Inclusion Criteria:

• Age 0-18 months of age
• Lack of ability to use the toilet

Exclusion Criteria:

• Lack of parental consent to participate in the study
• Parental inability to understand the study procedures

The group will be selected from the children admitted to the Department of Pediatrics The Medical University of Warsaw

Children between 2 and 18 months of age who were not toilet trained were eligible for the study. Exclusion criteria included parental inability to understand the study procedure and lack of parental consent to participate.

Limitations of our study included the lack of external validity. Children were recruited in only one paediatric department. Only one physician conducted stool assessment in vivo and only one physician evaluated photographs.