title: Validation of the modified Vesikari score in children with gastroenteritis in 5 US emergency departments.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *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.
authors.forename: David
authors.initials: D
authors.lastname: Schnadower
authors.forename: Phillip I
authors.initials: PI
authors.lastname: Tarr
authors.forename: Marc H
authors.initials: MH
authors.lastname: Gorelick
authors.forename: Karen
authors.initials: K
authors.lastname: O'Connell
authors.forename: Cindy G
authors.initials: CG
authors.lastname: Roskind
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Powell
authors.forename: Jayashree
authors.initials: J
authors.lastname: Rao
authors.forename: Seema
authors.initials: S
authors.lastname: Bhatt
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Freedman
mesh_terms: D000041:Absenteeism; D002675:Child, Preschool; D003681:Dehydration / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D005759:Gastroenteritis / Q000150:complications; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014481:United States