Sa1452 Predictive Validity of the Boston Bowel Preparation Score Within a Hospital Network Comprised of Various Practice Settings

Abstract

Sa1452 Predictive Validity of the Boston Bowel Preparation Score Within a Hospital Network Comprised of Various Practice Settings Evelyn O. Marquez*, Adeeti J. Chiplunker, Graham A. Colditz, Rebecca Lobb, Jean S. Wang Washington University, St Louis, MO Background: The Boston Bowel Preparation Scale (BBPS) allows for the grading of individual colonic segments (right, transverse, and left colon) to represent colonic visualization. We sought to predict the validity of the BBPS for adenoma detection within a hospital network comprised of various practice settings. Methods: A retrospective review was completed on all outpatient colonoscopies performed from May 2013 to April 2014 in six hospitals including those serving an academic tertiary referral practice, rural setting, inner-city underserved population, and suburban settings. Only colonoscopies that reached the cecum and had complete BBPS scoring were included. Endoscopy and pathology records were reviewed to determine the presence of adenomas. Using the BBPS, we defined adequate colonoscopies as those with scores in each of the three segments of 2 or greater. Inadequate colonoscopies were defined as those with at least 1 segment with a score of 1 or less. Results: A total of 5147 out of 5168 outpatient colonoscopies (57% female, mean age 58 years) met inclusion criteria. There were 23 colonoscopies that had a total BBPS score of 0; 11 had BBPS of 1; 14 had BBPS of 2; 138 had BBPS of 3; 108 had a BBPS of 4; 263 had a BBPS of 5; 1394 had a BBPS of 6; 799 had a BBPS of 7; 1037 had a BBPS of 8; 1373 had a BBPS of 9. Based on BBPS scores given to colonic segments, there were 4464 patients (86%) with adequate bowel preparation (scores in each of the three segments were 2 or greater) and 683 patients (13%) that had inadequate bowel preparation (at least one segment with a score of 1 or less). Adequate bowel preparation based on BBPS had a significantly higher adenoma detection rate (ADR) compared to inadequate bowel preparation with an ORZ1.19 (1.01-1.42), pZ0.04; ADR of 38.2% vs. 34.1%.We then tested various thresholds of total BBPS score. Using a cutoff of total BBPS score of 5, we found that BBPS scoresR5 were associated with significantly higher ADR compared to BBPS scores! 5 with an ORZ1.41 (1.091.82), pZ0.008; ADR of 38.1% vs. 30.4%. In contrast, when using a cutoff of total BBPS score of 6, we found BBPS scores R 6 did not have significantly different ADR compared to BBPS scores! 6 with an ORZ1.17 (0.97-1.41), pZ0.09. Conclusions: A higher BBPS score was associated with a higher ADR. Segment scores all R2 and a cut-off for total BBPS R5 predicted adenoma detection. Adequate bowel preparation throughout the colon based on BBPS (scores in each of the three segments were 2 or greater) had a significantly higher ADR compared to inadequate bowel preparation based on BBPS (at least 1 segment with a score of 1 or less). Total BBPS scores R5 were associated with a significantly higher ADR compared to total BBPS scores! 5.