Evaluating Acute Viral Gastroenteritis Severity: Modified Vesikari and Clark Scoring Systems

Abstract

Objective: Acute gastroenteritis (AGE) is the second leading cause of death in children worldwide. Objectively evaluating disease severity is critical for assessing future interventions. We used data from a large, prospective surveillance study to assess risk factors associated with severe presentation using modified Vesikari score (MVS) and Clark score (CS) of severity.

Methods: From December 1, 2012 to June 30, 2016, AGE surveillance was performed for children between 15 days and 17 years old in the emergency, inpatient, and outpatient settings at Vanderbilt's Monroe Carell Jr. Children's Hospital in Nashville, TN. Stool specimens were tested for norovirus, sapovirus, rotavirus, and astrovirus. We compared demographic and clinical characteristics, along with the MVS and CS, by viral detection status and by setting.

Results: Of the 6309 eligible children, 4216 (67%) were enrolled, with 3256 (77%) providing a stool specimen. The median age was 1.9 years, 52% were male, and 1387 (43%) of the stool samples were virus positive. Younger age, male sex, hospitalization, and rotavirus detection were significantly associated with higher mean MVS and CS. Non-Hispanic Black race and ethnicity was associated with a lower mean MVS and CS as compared with non-Hispanic white race and ethnicity. Prematurity and enrollment in the ED were associated with higher mean CS. The 2 scoring systems were highly correlated.

Conclusions: Rotavirus continues to be associated with more severe pediatric illness compared with other viral causes of AGE. MVS and CS systems yielded comparable results and can be useful tools to assess AGE severity.

FIGURE 1

Flow diagram of the study population presenting to Monroe Carell Children’s Hospital at Vanderbilt between December 2012 and June 2016.

FIGURE 2

Bar plot showing the distribution of viruses (A) singly detected or (B) codetected in the stool specimens of children with symptoms of acute gastroenteritis presenting to Monroe Carell Children’s Hospital at Vanderbilt between December 2012 and June 2016 (1, rotavirus; 2, norovirus; 3, sapovirus; 4, astrovirus; N = 1387).