Scoring Systems

Wael Solh and Steven D.Wexner

There are several disease processes in colon and rectal surgery with highly subjective presentations and clinical histories. These processes present a continuum rather than a discrete set of symptoms. Disorders that lend themselves to these scoring systems include fecal incontinence, constipation, and inflammatory bowel disease. These conditions share the common denominator of the clinician needing to try to give an objective meaning to otherwise subjective symptoms. Moreover, a quality-of-life (QOL) tool may be valid and a useful tool for any patient with any colorectal disease.

These scoring systems provide an objective measure of disease severity and can be uniformly applied among various institutions, which is important in establishing the comparability of patients. Hence, these systems can measure the effectiveness of posttherapeutic intervention. They also allow interpretation and comparison of data among centers. Importantly, they permit prospective images of the clinical outcomes of individual patients. The success and therefore longevity of any scoring system is obviously contingent upon both its accuracy and it simplicity. Unfortunately, the two factors are often inversely related, as in an attempt to be easy to apply, a score may not provide enough meaningful or reproducible data. Conversely, to be very reproducible and accurate, an excessive level of detail may preclude an easy to use format. Ideally, any scoring system should not sacrifice either desired feature.

A detailed patient history is the most accurate and reliable method of estimating the severity of fecal incontinence. However, to obtain objective data, numerous scoring or grading systems have been proposed in the literature. The majority of these systems only include the consistency of leakage but do not address the frequency of occurrence. Other scales mix historical data with data from physical examination or testing, as mentioned previously. These scores sacrifice discriminatory power for simplicity, but include numerical values that are arbitrarily assigned. These systems are summarized in Table 14-2.1.

We proposed and currently use the Cleveland Clinic Florida Scoring System (Table 14-2.2).1 This scoring system permits objective comparison of levels of incontinence among groups of patients. It has gained such global popularity because it fulfills the criteria of both simplicity and accuracy. Moreover, it permits comparison of the pre- and postoperative values, and hence, treatment results. These evaluations can be made in single patients and among different centers. Furthermore, as evidenced by the table, the fecal incontinence score can be quickly calculated by the clinician office nursing staff. This or any other scoring system,however, should not substitute for a comprehensive history. It has been our practice to provide a detailed questionnaire to assess the degree and frequency of incontinence and its effect on the patient's overall QOL. Other fecal incontinence severity scales include that proposed by Rockwood et al.,1 which is similar to the Cleveland Clinic Incontinence Scoring System (Table 14-2.3).

Constipation Prescription

Constipation Prescription

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