A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community Based Cohort Study

Gwenyth O. Lee

Research output: Contribution to journalArticle

Abstract

OBJECTIVES:: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multi-site, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), two previously published scores (Clark and CODA), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. METHODS:: Scores were built using maternally-reported symptoms or fieldworker-reported clinical signs obtained during the first seven days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. RESULTS:: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% CI: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with poorer weight gain, etiology, and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. CONCLUSIONS:: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the impact of disease control interventions, and in triaging children for referral in low and middle countries where the rates of morbidity and mortality following diarrhea remain high.This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

Original languageEnglish (US)
JournalJournal of Pediatric Gastroenterology and Nutrition
DOIs
StateAccepted/In press - Jun 24 2016

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Diarrhea
Hospitalization
Cohort Studies
Licensure
Patient Acceptance of Health Care
Dysentery
Dehydration
ROC Curve
Health Personnel
Weight Gain
Area Under Curve
Reproduction
Consensus
Referral and Consultation
Prospective Studies
Morbidity
Delivery of Health Care
Mortality
Health
Child Health

ASJC Scopus subject areas

  • Gastroenterology
  • Pediatrics, Perinatology, and Child Health

Cite this

@article{0cff21063853401eb5c552c9ca2eafba,
title = "A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community Based Cohort Study",
abstract = "OBJECTIVES:: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multi-site, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), two previously published scores (Clark and CODA), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. METHODS:: Scores were built using maternally-reported symptoms or fieldworker-reported clinical signs obtained during the first seven days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. RESULTS:: Of 10,159 episodes from 1681 children, 143 (4.0{\%}) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95{\%} CI: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with poorer weight gain, etiology, and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. CONCLUSIONS:: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the impact of disease control interventions, and in triaging children for referral in low and middle countries where the rates of morbidity and mortality following diarrhea remain high.This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0",
author = "Lee, {Gwenyth O.} and Lee, {Gwenyth O.} and Richard, {Stephanie A.} and Gagandeep Kang and Houpt, {Eric R.} and Seidman, {Jessica C.} and Pendergast, {Laura L.} and Bhutta, {Zulfiqar A.} and Tahmeed Ahmed and Mduma, {Estomih R.} and Lima, {Aldo A.} and Pascal Bessong and Jennifer, {Mats Steffi} and Hossain, {Md Iqbal} and Chandyo, {Ram Krishna} and Emanuel Nyathi and Lima, {Ila F.} and John Pascal and Sajid Soofi and Bodhidatta Ladaporn and Guerrant, {Richard L.} and Caulfield, {Laura E.} and Black, {Robert E.} and Kosek, {Margaret N.}",
year = "2016",
month = "6",
day = "24",
doi = "10.1097/MPG.0000000000001286",
language = "English (US)",
journal = "Journal of Pediatric Gastroenterology and Nutrition",
issn = "0277-2116",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - A Comparison of Diarrheal Severity Scores in the MAL-ED Multisite Community Based Cohort Study

AU - Lee, Gwenyth O.

AU - Lee, Gwenyth O.

AU - Richard, Stephanie A.

AU - Kang, Gagandeep

AU - Houpt, Eric R.

AU - Seidman, Jessica C.

AU - Pendergast, Laura L.

AU - Bhutta, Zulfiqar A.

AU - Ahmed, Tahmeed

AU - Mduma, Estomih R.

AU - Lima, Aldo A.

AU - Bessong, Pascal

AU - Jennifer, Mats Steffi

AU - Hossain, Md Iqbal

AU - Chandyo, Ram Krishna

AU - Nyathi, Emanuel

AU - Lima, Ila F.

AU - Pascal, John

AU - Soofi, Sajid

AU - Ladaporn, Bodhidatta

AU - Guerrant, Richard L.

AU - Caulfield, Laura E.

AU - Black, Robert E.

AU - Kosek, Margaret N.

PY - 2016/6/24

Y1 - 2016/6/24

N2 - OBJECTIVES:: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multi-site, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), two previously published scores (Clark and CODA), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. METHODS:: Scores were built using maternally-reported symptoms or fieldworker-reported clinical signs obtained during the first seven days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. RESULTS:: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% CI: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with poorer weight gain, etiology, and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. CONCLUSIONS:: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the impact of disease control interventions, and in triaging children for referral in low and middle countries where the rates of morbidity and mortality following diarrhea remain high.This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

AB - OBJECTIVES:: There is a lack of consensus on how to measure diarrheal severity. Within the context of a multi-site, prospective cohort study, we evaluated the performance of a modified Vesikari score (MAL-ED), two previously published scores (Clark and CODA), and a modified definition of moderate-to-severe diarrhea (MSD) based on dysentery and health care worker diagnosed dehydration. METHODS:: Scores were built using maternally-reported symptoms or fieldworker-reported clinical signs obtained during the first seven days of a diarrheal episode. The association between these and the risk of hospitalization were tested using receiver operating characteristic analysis. Severity scores were also related to illness etiology, and the likelihood of the episode subsequently becoming prolonged or persistent. RESULTS:: Of 10,159 episodes from 1681 children, 143 (4.0%) resulted in hospitalization. The area under the curve of each score as a predictor of hospitalization was 0.84 (95% CI: 0.81, 0.87) (Clark), 0.85 (0.82, 0.88) (MAL-ED), and 0.87 (0.84, 0.89) (CODA). Severity was also associated with poorer weight gain, etiology, and episode duration. Although families were more likely to seek care for severe diarrhea, approximately half of severe cases never reached the health system. CONCLUSIONS:: Community-based diarrheal severity scores are predictive of relevant child health outcomes. Because they require no assumptions about health care access or utilization, they are useful in refining estimates of the burden of diarrheal disease, in estimating the impact of disease control interventions, and in triaging children for referral in low and middle countries where the rates of morbidity and mortality following diarrhea remain high.This is an open access article distributed under the Creative Commons Attribution License 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

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