Development of a diarrhoea severity scoring scale in a passive health facility-based surveillance system

Abstract

Background Diarrhoeal disease remains a leading cause of death among children mostly in low and middle-income countries. Factors contributing to disease severity are complex and there is currently no consensus on a scoring tool for use in community-based studies. Methods Data were collected during a passive surveillance system in an outpatient health facility in Lusaka, Zambia from March 2019 to July 2019. Diarrhea episodes were assessed for severity using an in-house severity scoring tool (CIDRZ) and previously published scores (Vesikari, Clark, CODA, and DHAKA). The CIDRZ score was constructed using fieldworker-reported clinical signs and exploratory factor analysis. We used precision-recall curves measuring severe diarrhoea (i.e., requiring intravenous rehydration or referred for hospital admission) to determine the best performing scores. Then, we used Cronbach’s alpha to assess the scale’s internal consistency. Finally, we used Cohen’s kappa to assess agreement between the scores. Results Of 110 diarrhea episodes, 3 (3%) required intravenous rehydration or were referred for hospital admission. The precision-recall area under the curve of each score as a predictor of severe diarrhoea requiring intravenous rehydration or hospital admission was 0.26 for Vesikari, 0.18 for CODA, 0.24 for Clark, 0.59 for DHAKA, and 0.59 for CIDRZ. The CIDRZ scale had substantial reliability and performed similarly to the DHAKA score. Conclusions Diarrhoea severity scores focused on characteristics specific to dehydration status may better predict severe diarrhea among children in Lusaka. Aetiology-specific scoring tools may not be appropriate for use in community healthcare settings. Validation studies for the CIDRZ score in diverse settings and with larger sample sizes are warranted.

Prevalence of Diarrhoeagenic Escherichia coli among Children Aged between 0–36 Months in Peri-Urban Areas of Lusaka

“…Antibiotics are only prescribed under specific circumstances as stipulated in the treatment guidelines [15]. Clinicians documented the general condition of the participants and assessed the severity of diarrhoea using an in-house developed diarrhoea severity scoring tool [16]. One stool sample was collected from each child for the detection of DEC pathotypes.…”

The Incidence and Risk Factors for Enterotoxigenic E. coli Diarrheal Disease in Children under Three Years Old in Lusaka, Zambia

“…To assess the severity of diarrhea, three scoring methods were utilized, namely DHAKA [14], VERSIKARI [15], and the CIDRZ score [16], which is a composite score based on the parameters included in the DHAKA, CLARK, WHO, and VERSIKARI.…”

A Perspective on the Strategy for Advancing ETVAX®, An Anti-ETEC Diarrheal Disease Vaccine, into a Field Efficacy Trial in Gambian Children: Rationale, Challenges, Lessons Learned, and Future Directions

“…Therefore, the capacity of research staff to accurately evaluate the degree of diarrhea severity (e.g., mild, moderate, severe) is vital. Several quantifiable scoring systems have been proposed and evaluated to measure clinical severity, including, but not limited to, the World Health Organization [ 68 ], Vesikari [ 69 ], CODA [ 70 ], Clark [ 71 ], Dhaka [ 70 ], and CIDRZ [ 72 ] systems. These scoring systems largely rely on clinical evaluation and mathematical scoring of selected signs and symptoms.…”