소아 급성 위장관염의 중증도 평가를 위한 기존 중증도 점수 척도들의 비교
Comparison among Known Severity Scoring Scales in the Evaluation of Acute Gastroenteritis in Children
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목적: 급성 위장관염으로 입원한 소아 환자들의 중증도를 여러 척도로 평가하여 각 척도간의 차이를 비교하고, 원인 바이러스가 밝혀진 예를 따로 분류하여 원인 병원체에 따른 임상양상 및 중증도의 차이를 알아보고자 하였다. 방법: 전향적으로 전국 8개 지역 9개 의료기관의 소아청소년과에 급성 위장관염으로 진단받아 입원한 5세 미만의 환자를 대상으로 Vesikari 척도, Clark 척도, 수정 Flores 척도로 중증도를 평가하였다. 연구군으로부터 수집된 분변 검체로 로타바이러스, 장 아데노바이러스는 효소면역법으로, 노로바이러스, 아스트로바이러스, 사포바이러스는 RT-PCR 방법으로 검출하였다. 결과:최종 연구 대상군은 총 214례로 남녀비는 1.58: 1이고, 연령층은 6개월 미만이 35명(16.4%), 6-23개월이 105명(49.1%), 24-59개월이 74명(34.5%)이었다. Vesikari 척도와 Clark 척도간 일치율은 0.521 (P< 0.001)이고, ‘중증’인 경우가 Vesikari 척도는 60.7%, Clark 척도는 2.3%로 Clark 척도가 ‘중증’ 평가에 더욱 엄격하였다. 결론: 급성 위장관염의 중증도를 평가하는 각 척도들간에는 차이가 있었다. 각 연구자들의 결과를 객관적으로 비교하기 위해서는 척도를 하나로 통일하거나 각 척도들의 평가기준을 모두 조사하여 각 척도의 중증도를 동시에 얻는 것이 필요하다.
Abstract
Purpose: This study aimed to evaluate the disease severity of children suffering from gastroenteritis using different scales. The results are compared and subsequently classified on the basis of the type of virus causing the disease in order to investigate the differences in clinical characteristics and disease severity according to pathogen. Method: This study was conducted prospectively with patients under 5 years of age diagnosed with acute gastroenteritis and hospitalized at 9 medical institutions in 8 regions across the Republic of Korea. Disease severity was evaluated using the Vesikari Scale, the Clark Scale, and the modified Flores Scale. Fecal samples collected from patients were used to detect rotavirus and enteric adenovirus by enzyme immunoassay, and for RT-PCR of norovirus, astrovirus, and sapovirus. Results: There were a total of 214 patients with a male : female ratio of 1.58 : 1, of which 35 were under the age of 6 months (16.4%), 105 were aged 6-23 months (49.1%), and 74 were aged 24-59 months (34.5%). The rate of concordance between the Vesikari and Clark Scales was 0.521 (P<0.001) and, in severe cases, the Vesikari Scale was 60.7% and Clark Scale was 2.3%, indicating that the Clark Scale was stricter in the evaluation of severe cases. Conclusions: In children with gastroenteritis, there were differences in disease severity based on the scale used. Therefore, to achieve consistent results among researchers, either only a single scale or a measure of all scales should be used to determine disease severity.
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