Whilst comfort scoring is an auditable standard for quality in colonoscopy, there is currently no widely accepted comfort score for gastroscopy. We developed a five point gastroscopy toleration score (GTS) and validated correlation of scoring between endoscopists, patients and nursing staff.Methods
A GTS was developed via consensus on a gastroscopy list (figure 1). Trial 1 of the finalised ‘Bath GTS’ involved a double blind collection from the endoscopist and two nurses during 47 gastroscopies to determine inter-observer correlation between staff. Trial 2 involved a double blind collection from the endoscopist, nurse and unsedated patient during 50 additional cases. Krippendorff’s alpha(α) coefficient was calculated to assess inter-rater reliability. We then analysed sub-group matches between endoscopist-nurse, endoscopist-patient and nurse-patient.Results
A total of 97 gastroscopies were included in the analysis. In Trial 1 the inter-rater correlation between nurses and endoscopist was excellent (Krippendorff’s α=0.811 (95% CI 0.73–0.88)). There were no matched scores in 1 case (2.1%), at least two matched scores in 46 cases (97.9%) and three matched scores in 34 cases (72.3%).Results
Trial 2 demonstrated at least two matched scores in all 50 cases (100%) and three matched scores in 39 cases (78%) with excellent correlation between raters (α=0.833 (95%CI 0.75–0.90)). Subgroup analysis demonstrated that of the gastroscopies with only two matched scores, endoscopist-nurse matches totalled 8 cases (72.3%), endoscopist-patient matches totalled 2 cases (18.2%) and nurse-patient matches 1 case (9.10%). Krippendorff’s α for these subgroups were 0.930 (95% CI 0.84–1.00), 0.800 (95%CI 0.63–0.93) and 0.774 (95%CI 0.60–0.92) respectively. Final analysis comparing endoscopist-nurse matched scores from all 97 gastroscopies showed significant agreement (α=0.858 (95%CI 0.81–0.91)).Conclusions
We have presented a simple yet effective GTS which was validated for inter-observer correlation between endoscopists and nurses with statistically significant agreement. Furthermore, there is excellent correlation when the GTS from unsedated patients is compared with that of staff (α=0.833(CI 0.75–0.90). Given the agreement between unsedated patients and staff regarding procedure toleration, this scoring system could be applied to sedated patients. We would suggest that the Bath GTS is adopted as a validated national auditable outcome for gastroscopy with further work in progress to determine the standard.