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

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://ift.tt/1eRPUFd (C) 2016 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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