Model may help identify inpatients with inadequate colon cleansing
Odds of inadequate cleansing were higher in patients who were bedridden or constipated, those with diabetes, those taking antipsychotic drugs, and those hospitalized for seven days or longer.
Inpatients could benefit from a model aimed at identifying inadequate colon cleansing before colonoscopy, according to a recent study.
Researchers in Italy performed an observational study at 12 hospitals in consecutive inpatients who were scheduled for colonoscopy for any reason, other than emergency or elective therapeutic colonoscopy. Patients whose bowel preparation was done outside the hospital were also excluded. The goal of the study was to determine factors associated with inadequate colon cleansing and to develop and validate a model that could be used to identify such patients. Patients seen from February through May 2019 acted as the derivation cohort, and those seen from June through August 2019 acted as the validation cohort. The study results were published March 18 by Clinical Gastroenterology and Hepatology.
One thousand sixteen patients were included in the derivation cohort, and 508 were included in the validation cohort. Fifty-four percent of the overall study sample were men, and the mean age was 69 years. Colon cleansing was considered adequate in 1,032 patients (68%) among both cohorts. Seven hundred seventeen patients (47%) received high-volume preparation, 624 (41%) received low-volume, and 183 (12%) received very low-volume. Odds of inadequate colon cleansing were significantly lower if physicians held meetings to optimize bowel preparation (odds ratio [OR], 0.42; 95% CI, 0.27 to 0.65), if patients received written and oral instructions (OR, 0.48; 95% CI, 0.36 to 0.65), if patients were admitted to a gastroenterology unit (OR, 0.71; 95% CI, 0.51 to 0.98), if they received split-dose regimens (OR, 0.27; 95% CI, 0.20 to 0.35) or a 1-L polyethylene glycol-based bowel purge (OR, 0.39; 95% CI, 0.23 to 0.65), or if preparation intake was at least 75% (OR, 0.09; 95% CI, 0.05 to 0.15).
Odds of inadequate bowel cleansing were higher in patients who were bedridden (OR, 2.14; 95% CI, 1.55 to 2.98) or constipated (OR, 2.16; 95% CI, 1.55 to 3.0), those who had diabetes (OR, 1.61; 95% CI, 1.18 to 2.20), those taking antipsychotic drugs (OR, 3.26; 95% CI, 1.62 to 6.56), and those hospitalized for seven days or longer (OR, 1.02; 95% CI, 1.00 to 1.04). The authors developed a model identifying patients at risk for inadequate bowel cleansing and tested it in the validation cohort. The model had calibration values of P=0.218 and P=0.232 for the discrimination cohort and validation cohort, respectively. C-statistics for discrimination were 0.78 (95% CI, 0.74 to 0.81) and 0.73 (95% CI, 0.69 to 0.78), respectively.
Choice of bowel preparation was not standardized, no data were provided regarding the effect of colon cleansing on costs and length of stay, and the study involved only hospitalized patients, among other limitations, the authors noted. “The finding that nearly one-third of inpatients had an inadequate colon cleansing confirms that this population is hard-to-prepare and underlines the need of an extra effort to improve quality in this setting,” they wrote. They concluded that identifying risk factors for inadequate colon cleansing might help improve identification of inpatients who require interventions to meet quality standards for colonoscopy.