Comfort Score for Colonoscopy. Do we all get it right?
SR Ahmed, S. Carey, A. Morcos
Endosocpy Suite, University Hospital Waterford
Colonoscopy is commonly performed to investigate colonic symptoms. British Society of Gastroenterology suggests Ceacal Intubation Rate (CIR) as its prime quality indicator. As a consequence, individuals with poor technique may push harder and persist for longer to achieve this standard. This could lead to more pain, sedation levels and sedation related complications. This study aimed to analyze the difference in allocation of CS by Nurses (NCS) and endoscopists (ECS) in conjunction with CIR and procedure times.
To explore the relationship of patient comfort score allocated by nurses versus endoscopists in relation to Ceacal Intubation Rate and Procedure time as performance indicators for colonoscopy and to compare the outcome.
All colonoscopies performed in our endoscopy unit were recorded in a period between from 8th September 2014 to 24th October 2014. All procedures were performed by qualified endoscopists and their trainees. The following variables were measured: NCS and ECS on a scale from 1 to 5(Gloucester Comfort Score), CIR, procedure duration and use of sedation and analgesia. Pearson’s correlation coefficient was used to identify relationships between performance indicators. Friedman test was used to analyze the CS.
Total 193 Colonoscopies were performed. The median age was 58y (IQR 47-73y) of which 91(47%) were males. The sedation used was a combination of midazolam (100%) and an opiate, fentanyl (88.1%) or pethidine (5.2%). Buscopan was also used (6.7%). The median midazolam dose used was 5mg (SD1.8mg), Fentanyl 25mcg (SD27.0) and Pethidine 50mg (SD 7.9). The average midazolam dose was negatively correlated with CIR (r = -0.028, P 0.70). There was also a positive correlation between midazolam dose and NCS (r = 0.239, P 0.01) and ECS(r=0.212 P 0.03) however to a lesser extent. The average CIR was 79.8%, negatively correlated with the higher NCS(r=-0.112 P0.121) and again to a lesser extent ECS(r=-0.127 P 0.79). Friedman test was employed to evaluate difference between NCS and ECS. It was statistically significant χ2(1) = 17.26, P < 0.01. Follow up Post-hoc analysis with Wilcoxon signed-rank test was conducted controlling for type 1 error and demonstrated significant difference between the two groups (P < 0.01).
Higher sedation dose and Procedure time were unrelated to CIR statistically. Furthermore NCS was found to be distributed differently from ECS suggesting a need for standardization. Furthermore A low CIR(<90%) suggested need for more training in the Unit. This audit should be cycled in a 12 month period to see the effectiveness.