An Evaluation of Enteropathogen-Specific Disease Severity and Duration in Children With Acute Gastroenteritis

Objectives: Our primary objectives were to describe pathogen-specific symptom severity and duration in a prospective cohort study of children with acute gastroenteritis (AGE). Our secondary objective was to quantify health care resource utilization. Methods: This secondary analysis of 2 trials included children aged 3 to 48 months with AGE. Children were eligible if they had ≥3 watery stools in the preceding 24 hours and were brought to the Emergency Department. Disease severity was quantified by frequency and duration of vomiting and diarrhea, and the Modified Vesikari Scale score. We used descriptive statistics to summarize severity and regression models to identify associations between pathogen type and outcomes. Results: In total, 1565 trial participants had pathogen testing performed and completed follow-up. Viral pathogens were identified in 47.9% (749/1565) and bacterial pathogens in 5.9% (92/1565). Norovirus (322/1565; 20.6%) was the most frequently identified pathogen. Diarrhea duration was greatest (median 160h, IQR: 98, 216) for children with Salmonella . Vomiting (aOR: 11.02; 95% CI: 7.47, 16.26) occurred more commonly in children with viruses compared with bacteria. The mean duration of diarrhea was shorter for viruses compared with bacteria (aIRR: 0.81, 95% CI: 0.68, 0.96). Mean MVS scores were higher in children with viruses compared with those with bacteria (coefficient: 1.64, 95% CI: 0.46, 2.82). Conclusions: We describe the clinical course of viral and bacterial pathogens. Although statistically significant, differences in symptom severity across pathogens were not clinically meaningful for distinguishing between them based on symptoms alone.