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Initial validation of the global assessment of severity of illness

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Abstract

Scales currently validated to assess severity of chronic physical conditions in children are not well suited for limited-resource settings as they lack ease of use and interpretation. This study assessed the validity of the Global Assessment of Severity of Illness (GASI), a single-item scale designed for quick and simple assessment of illness severity in children with various chronic physical conditions. Study objectives were to examine validity, reliability, and responsiveness of the GASI. Clinicians assessed the severity of asthma, food allergy, epilepsy, diabetes, and juvenile arthritis in 55 children, and parents reported on children’s health-related quality of life. Area under the curve (AUC) computed by logistic regression and Kendall’s Tau-c (τc) assessed the strength of association between the GASI and other study measures. The kappa coefficient (κ), weighted kappa (κw), and McNemar’s test assessed stability in GASI ratings over time. The standardized response mean and Guyatt’s responsiveness index examined internal and external responsiveness of the GASI, respectively. The GASI correlated strongly with established severity scales (AUC = 0.83–0.96; τc = 0.57–0.78) and did not correlate with health-related quality of life (τc < 0.1). Moderate (κw = 0.57) to substantial (κ = 0.79) test–retest reliability was supported and the magnitude of responsiveness was large (d = 0.83–3.83). This study provided initial evidence of excellent construct validity and responsiveness in the GASI and also supported acceptable test–retest reliability in a clinical sample of children with physical conditions. Future research using larger samples should aim to replicate these findings to improve feasibility of standardized assessment in limited-resource settings and facilitate cross-condition comparisons in pediatric research.

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Acknowledgements

The authors gratefully acknowledge the children, parents, and health professionals and their staff without whose participation this study would not have been possible.

Funding

This research was supported by a grant from the Canadian Institutes of Health Research (MOP-133645). Mr. Tompke was supported by funds from the Early Researcher Award from the Ministry of Research, Innovation and Science awarded to Dr. Ferro. Dr. Ferro holds the Canada Research Chair in Youth Mental Health.

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Authors and Affiliations

  1. School of Public Health Sciences, University of Waterloo, 200 University Avenue West, TJB 231, Waterloo, ON, N2L 3G1, Canada

    Braden K. Tompke, Ashok Chaurasia, Christopher Perlman & Mark A. Ferro

  2. Department of Paediatrics, Western University, London, Canada

    Kathy N. Speechley

  3. Department of Epidemiology and Biostatistics, Western University, London, Canada

    Kathy N. Speechley

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  1. Braden K. Tompke
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  2. Ashok Chaurasia
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  3. Christopher Perlman
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Correspondence to Mark A. Ferro.

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This study was secondary data analysis of de­identified data from an already completed study and no participants were recruited.

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Tompke, B.K., Chaurasia, A., Perlman, C. et al. Initial validation of the global assessment of severity of illness. Health Serv Outcomes Res Method 22, 228–243 (2022). https://doi.org/10.1007/s10742-021-00260-w

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