*Division of Pediatric Emergency Medicine †Division of Gastroenterology, Hepatology, and Nutrition, Washington University School of Medicine in St Louis, St Louis, MO ‡Division of Pediatric Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI §Division of Pediatric Emergency Medicine, Children's National Medical Center, Washington DC ||Division of Pediatric Emergency Medicine, Columbia University College of Physician and Surgeons, New York, NY ¶Division of Pediatric Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL #Division of Pediatric Emergency Medicine, Wayne State School of Medicine, Detroit, MI **Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH ††Sections of Paediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada.
J Pediatr Gastroenterol Nutr. 2013 Oct;57(4):514-9. doi: 10.1097/MPG.0b013e31829ae5a3.
The burden of acute gastroenteritis (AGE) in US children is substantial. Research into outpatient treatment strategies has been hampered by the lack of easily used and validated gastroenteritis severity scales relevant to the populations studied. We sought to evaluate, in a US cohort, the reliability, construct validity, and generalizability of a gastroenteritis severity scale previously derived in a Canadian population, the modified Vesikari score (MVS).
We conducted a prospective, cohort, clinical observational study of children 3 to 48 months of age with acute gastroenteritis presenting to 5 US emergency departments. A baseline MVS score was determined in the emergency department, and telephone follow-up 14 days after presentation was used to assign the follow-up MVS. We determined reliability using inter-item correlations; construct validity via principal component factor analysis; cross-sectional construct validity via correlations with the presence of dehydration, hospitalization, and day care and parental work absenteeism; and generalizability via score distribution among sites.
Two hundred eighteen of 274 patients (80%) were successfully contacted for follow-up. Cronbach α was 0.63, indicating expectedly low internal reliability because of the multidimensional properties of the MVS. Factor analysis supported the appropriateness of retaining all variables in the score. Disease severity correlated with dehydration (P < 0.001), hospitalization (P < 0.001), and subsequent day care (P = 0.01) and work (P < 0.001) absenteeism. The MVS was normally distributed, and scores did not differ among sites.
The MVS effectively measures global severity of disease and performs similarly in varying populations within the US health care system. Its characteristics support its use in multisite outpatient clinical trials.
美国儿童急性肠胃炎（AGE）的负担很重。由于缺乏与所研究人群相关的易于使用和验证的肠胃炎严重程度量表，因此对外门诊治疗策略的研究受到了阻碍。我们试图在美国队列中评估先前在加拿大人群中得出的肠胃炎严重程度量表（改良 Vesikari 评分，MVS）的可靠性、结构有效性和普遍性。
我们对 5 家美国急诊室就诊的 3 至 48 个月龄患有急性肠胃炎的儿童进行了前瞻性、队列、临床观察研究。在急诊室确定基线 MVS 评分，并在就诊后 14 天通过电话随访确定随访 MVS 评分。我们通过项目间相关性来确定可靠性；通过主成分因子分析来确定结构有效性；通过与脱水、住院、日托和父母旷工的相关性来确定横断面结构有效性；通过各站点之间的评分分布来确定普遍性。
274 名患者中有 218 名（80%）成功联系进行了随访。Cronbach α 为 0.63，表明由于 MVS 的多维性质，内部可靠性预期较低。因子分析支持保留评分中所有变量的适当性。疾病严重程度与脱水（P < 0.001）、住院（P < 0.001）以及随后的日托（P = 0.01）和旷工（P < 0.001）显著相关。MVS 呈正态分布，且各站点之间的评分无差异。
MVS 能有效评估疾病的总体严重程度，且在美国医疗保健系统内的不同人群中表现相似。其特征支持在多站点门诊临床试验中使用。
