Will a SQUIRT Score Be Helpful?

A recent letter to the editor: J Rauh et al. Stool Quality for Intestinal Rehabilitation Therapy (SQUIRT) Score, JPS 2022. doi: https://doi.org/10.1016/j.jpedsurg.2022.08.025

The authors have devised a SQUIRT score for short bowel syndrome. The higher score indicates better enteral tolerance with a highest score of 13 and a lowest score is 3. It is a composite score based on composition, frequency and volume/blowouts. The authors define a blow-out to be a stool loose enough and large enough for the child to require a change of clothes.

How to Score:

Consistency (choose best stool of the day)
Playdough, Formed 5
Peanut Butter, Pasty 4
Pudding, Seedy 3
Pea Soup, Loose 2
Water 1

Occurrences (over 24 hours)
1 to 3 4
4 to 6 3
7 to 9 2
Greater Than 10 1
Ostomy Present 0

With Ostomy Without Ostomy
(mL/kg) (# of blowouts)

  • < 10 mL/kg 8 0 =4
  • 10 -14 mL/kg 7
    15-19 mL/kg 6 1 =3
  • 20-24 mL/kg 5 2 =2
    25-29 mL/kg 4
  • 30-34 mL/kg 3
  • 35 mL/kg 2
  • >35 mL/kg 1 >3 =1

The authors state that this scoring system has been used in their institution. “This tool can provide objective information to guide clinical decision making. Even patients with ostomies, for whom we can measure stool volume, benefit from SQUIRT scores because including the variable of stool consistency provides a more nuanced assessment than relying on volume.”

My take:This type of scoring system would be useful, primarily in patients in which the volume of stool is difficult to measure. It would benefit from trials to validate its utility.

Related blog posts for Short Bowel Syndrome:

American Windows by Marc Chagall, at the Art Institute of Chicage