Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children

Jee-Hyun Choi; Tae Woong Jung; Seong Joon Kim; Ju-Young Chung; Min-Sung Kim; Seung Beom Han; Jin-Han Kang; Sang Yong Kim; Jung Woo Rhim; Hwang-Min Kim; Jae Hong Park; Dae Sun Jo; Sang Hyuk Ma; Hye-Sook Jeong; Doo-Sung Cheon; Dae Kyun Koh; Jong-Hyun Kim

doi:10.14776/kjpid.2014.21.1.43

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Choi, Jung, Kim, Chung, Kim, Han, Kang, Kim, Rhim, Kim, Park, Jo, Ma, Jeong, Cheon, Koh, and Kim: Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children

Original Article

Korean Journal of Pediatric Infectious Diseases 2014; 21(1): 43-52.

Published online: 23 April 2014

DOI: https://doi.org/10.14776/kjpid.2014.21.1.43

Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children

Jee-Hyun Choi, M.D., Tae Woong Jung, M.D., Seong Joon Kim, M.D., Ju-Young Chung, M.D.^*, Min-Sung Kim, M.D., Seung Beom Han, M.D., Jin-Han Kang, M.D., Sang Yong Kim, M.D., Jung Woo Rhim, M.D., Hwang-Min Kim, M.D.^†, Jae Hong Park, M.D.^‡, Dae Sun Jo, M.D.^∫, Sang Hyuk Ma, M.D.^∥, Hye-Sook Jeong, Ph.D.^¶, Doo-Sung Cheon, Ph.D.^¶, Dae Kyun Koh, M.D., Jong-Hyun Kim, M.D.

Department of Pediatrics, College of Medicine, The Catholic University of Seoul, Korea.

^*Department of Pediatrics, College of Medicine, Inje University of Pusan, Korea.

^†Department of Pediatrics, College of Medicine, Yonsei University of Wonju, Korea.

^‡Department of Pediatrics, College of Medicine, Busan National University, Busan, Korea.

^∫Department of Pediatrics, College of Medicine, Chonbuk National University of Jeonju, Korea.

^∥Department of Pediatrics, Changwon Fatima Hospital, Changwon, Korea.

^¶Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongwon, The Republic of Korea.

Corresponding author (jh00mn@catholic.ac.kr)

Received 18 October 2013 Revised 6 December 2013 Accepted 15 December 2013

Abstract

Purpose

This study aimed to evaluate the disease severity of children suffering from gastroenteritis using different scales. The results are compared and subsequently classified on the basis of the type of virus causing the disease in order to investigate the differences in clinical characteristics and disease severity according to pathogen.

Method

This study was conducted prospectively with patients under 5 years of age diagnosed with acute gastroenteritis and hospitalized at 9 medical institutions in 8 regions across the Republic of Korea. Disease severity was evaluated using the Vesikari Scale, the Clark Scale, and the modified Flores Scale. Fecal samples collected from patients were used to detect rotavirus and enteric adenovirus by enzyme immunoassay, and for RT-PCR of norovirus, astrovirus, and sapovirus.

Results

There were a total of 214 patients with a male : female ratio of 1.58 : 1, of which 35 were under the age of 6 months (16.4%), 105 were aged 6-23 months (49.1%), and 74 were aged 24-59 months (34.5%). The rate of concordance between the Vesikari and Clark Scales was 0.521 (P<0.001) and, in severe cases, the Vesikari Scale was 60.7% and Clark Scale was 2.3%, indicating that the Clark Scale was stricter in the evaluation of severe cases.

Conclusions

In children with gastroenteritis, there were differences in disease severity based on the scale used. Therefore, to achieve consistent results among researchers, either only a single scale or a measure of all scales should be used to determine disease severity.

Keywords: Gastroenteritis, Clinical scoring system, Child

Figures and Tables

Fig. 1

Detection status of causative viruses in 214 acute gastroenteritis episodes in admitted children <5 years old.

Table 1

Criteria of Three Gastroenteritis Severity Scoring Systems

Abbreviations: NA, not applicable

^*Non-severe (<9); severe (9-14); very severe (≥15)

^†Mild (<9);moderate (9-16);severe (≥17)

^‡Non-severe(<11); severe(≥11)

Table 2

Comparison of Clinical Scoring Scale between Gender and Age Groups

^*Mann-Witney U test

^†Differences between 6-23 months age group and other two age groups

Table 3

The Relationship between Vesikari and Clark Scoring Scales in 214 Acute Gastroenteritis Episodes in Admitted Children <5 Years Old

Kappa=0.521 (P<0.001)

Table 4

The Relationship between Vesikari and Modified Flores Scoring Scales in 214 Acute Gastroenteritis Episodes in Admitted Children <5 Years Old

Kappa=-0.109 (P<0.001)

Table 5

The Relationship between Clark and Modified Flores Scoring Scales in 214 Acute Gastroenteritis Episodes in Admitted Children <5 Years Old

Kappa=-0.091 (P=0.007)

Table 6

Maximal Number per Day and Duration of Diarrhea and Vomiting According to the Types of Viruses in Admitted Children <5 Years Old with Acute Gastroenteritis

Table 7

Three Severity Scoring Scales According to the Types of Viruses in Admitted Children <5 Years Old with Acute Gastroenteritis

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