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Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation

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Abstract

Background and aims

Adequate bowel preparation (BP) is crucial for the diagnosis of colorectal diseases. Identifying patients at risk of inadequate BP allows for targeted interventions and improved outcomes. We aimed to develop a model for predicting inadequate BP based on preparation-related factors.

Methods

Adult outpatients scheduled for colonoscopy between May 2022 and October 2022 were enrolled. One set (N = 913) was used to develop and internally validate the predictive model. The primary predictive model was displayed as a nomogram and then modified into a novel scoring system, which was externally validated in an independent set (N = 177). Inadequate BP was defined as a Boston Bowel Preparedness Scale (BBPS) score of less than 2 for any colonic segment. The model was evaluated by the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA).

Results

Independent factors included in the prediction model were stool frequency ≤ 5 (15 points), preparation-to-colonoscopy interval ≥ 5 h (15 points), incomplete dosage (100 points), non-split dose (90 points), unrestricted diet (88 points), no additional water intake (15 points), and last stool appearance as an opaque liquid (0–80 points). The training set exhibited the following performance metrics for identifying BP failure: area under the curve (AUC) of 0.818, accuracy (ACC) of 0.818, positive likelihood ratio (PLR) of 2.397, negative likelihood ratio (NLR) of 0.162, positive predictive value (PPV) of 0.850, and negative predictive value (NPV) of 0.723. In the internal validation set, these metrics were 0.747, 0.776, 2.099, 0.278, 0.866, and 0.538, respectively. The external validation set showed values of 0.728, 0.757, 2.10, 0.247, 0.782, and 0.704, respectively, indicating strong discriminative ability. Calibration curves demonstrated close agreement, and DCA indicated superior clinical benefits at a threshold probability of 0.73 in the training cohort and 0.75 in the validation cohort for this model.

Conclusions

This novel scoring system was developed from a prospective study and externally validated in an independent set based on 7 easily accessible variables, demonstrating robust performance in predicting inadequate BP.

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Data availability

Data for this study can be obtained by contacting corresponding authors.

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Acknowledgements

Not applicable.

Funding

The research was funded by the special fund project for the doctoral training program of Lanzhou University Second Hospital (No. PR5124007).

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Authors and Affiliations

  1. Department of Gastroenterology, Lanzhou University Second Hospital, No. 82 Cuiying Men, Cheng Guan District, Lanzhou, 730030, Gansu, China

    Xiaxia Zhao, Jinyong Hao, Jie Feng, Zhongyuan Cui, Huimin Ma & Xiaojun Huang

  2. Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 Changle West Road, Xi’an, 710032, Shanxi, China

    Yanglin Pan

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Contributions

Xiaxia Zhao, Xiaojun Huang and Yanlin Pan were the guarantors of this paper and are responsible for the manuscript (including data collation and analysis). Xiaxia Zhao, Xiaojun Huang, Jinyong Hao, JieFeng and Huimin Ma were involved in the design of the study. Xiaxia Zhao collected the data. Zhongyuan Cui was involved in the analysis of the data. Xiaxia Zhao drafted the manuscript. All authors agreed to submit the final version.

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Correspondence to Xiaxia Zhao.

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Zhao, X., Pan, Y., Hao, J. et al. Development and validation of a novel scoring system based on a nomogram for predicting inadequate bowel preparation. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03443-2

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