Lindeboom, J. (Jeanet) (2014) Recognition of pale-pigmented stools by parents in the Netherlands: the effect of the Infant Stool Colour Card. thesis, Medicine.
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Abstract
Introduction Biliary atresia (BA) is a rare, but life-threatening disease of infancy, in which progressive fibro-obliteration of all or part of the extrahepatic biliary tree leads to cholestasis and liver cirrhosis. Surgical reconstruction of the bile ducts (the Kasai procedure) is the only option to prevent liver transplantation. BA patients have the best prognosis if they undergo a Kasai procedure before the age of 60 days. Therefore, early recognition of the symptoms of neonatal cholestasis is crucial. One of the earliest symptoms are pale-pigmented stools. However, parents may often not be alarmed by pale-pigmented stools, leading to delayed diagnosis of biliary atresia. The Taiwan Stool Color Card (“Infant Stool Colour Card”, ISCC) has been described as a simple, cost-effective and convenient screening method for BA, leading to improved outcomes. Aim of the study This study aimed to examine whether parents in Groningen recognised pale-pigmented stools and whether they were aware of the importance to seek medical help in case of pale-pigmented stools. Secondly, the effect of using the ISCC on parents’ recognition of abnormal stools was analysed. Third, sensitivity and specificity of the ISCC for diagnosing pale-pigmented stools and the effect of adequate education about the use and objective of the ISCC were calculated. Design and methods A regional pilot study was conducted under parents and caretakers of infants that visited one of two youth health clinics in Groningen for the routine one-month health check. Participants were shown a total of 10 photographs of infant stool samples: 6 of normal coloured stools and 4 of pale-pigmented stools. Parents were asked whether they thought the stools were normal or abnormal and if they would contact a health professional in case their child would have similar stools. Then, they were asked which number on the ISCC was most similar to the stool samples on the individual pictures. Group 1 (n=50) received no education concerning the ISCC; group 2 (n=50) did. Results 92% of all parents in our sample of 100 parents recognised at least 3 out of 4 of the pale-pigmented stool pictures as “abnormal”. However, 34% failed to recognise at least one picture of pale stools as “abnormal”. 49% of participants would seek medical help for all of the pale stool pictures. Overall, parents would seek medical help for 78% of pale pigmented stools. 53% of participants labelled at least 3 of all 6 pictures of normal stools as “abnormal” and 39% would seek medical help for at least 3 out of 6 pictures of normal stools. Overall sensitivity and specificity of the ISCC for recognition of pale-pigmented stools by parents were 96,5% and 99,0%. We could not demonstrate a significant difference in recognising abnormal stools in participants that did and did not receive education about the ISCC. Conclusion Parents did not recognise all of the pale-pigmented stools and were not as alarmed as they should be by pale-pigmented infant stools. Our findings support the evidence that a screening tool like the Infant Stool Colour Card could help parents identify abnormal, pale-pigmented stools from normal coloured stools. The standard one-month health check in the Netherlands would be an optimal time for identification of BA in the Netherlands.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hulscher, J.B.F. MD/PhD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/238 |
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