The rumination severity index: Development and evaluation of a scoring tool for rumination syndrome

OBJECTIVES: Rumination syndrome (RS) is increasingly recognized in pediatrics; however, no tool exists to measure RS severity in children. Thus, the rumination severity index (RumSI) was developed and validated to measure rumination severity in children. METHODS: We developed a seven-item patient-reported questionnaire, the RumSI, to evaluate RS symptoms and impact on functioning based on clinical experience of pediatric gastroenterologists and psychologists who specialize in caring for children with RS. Patients with RS evaluated at our institution or their parents/caregivers were asked to complete the RumSI and the Pediatric Quality of Life Inventory (PedsQL) as part of clinical care. An overall RumSI score was calculated and analyzed for correlation with PedsQL. Intrarater and test-retest reliability were assessed in a validation cohort. RESULTS: Among 105 children with RS, 66 completed RumSI and PedsQL questionnaires (71% female, median age of 15 years, interquartile range 13-17) for a 63% completion rate. RumSI scores ranged from 0 to 26.5 (mean 10.6 ± 7.2) out of a total possible 28, with higher scores indicating worse rumination symptoms. RumSI and PedsQL scores were significantly negatively correlated (r = -0.45, p < 0.001), with every 1-point increase in RumSI score associated with a 1.3-point decrease in PedsQL total score. Test-retest reliability was strong (intraclass correlation coefficient = 0.84). CONCLUSIONS: The newly developed RumSI is the first validated tool designed to measure RS severity in children. RumSI scores negatively correlate well with a widely used pediatric quality of life measure and demonstrate strong test-retest reliability, supporting its use in both clinical care and research.