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The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability

KidZ Health Castle, UZ Brussel, Brussels, Vrije Universiteit Brussel, 1090 Brussels, Belgium
Department of Paediatrics, Hospital Casa de Salud, 46021 Valencia, Spain
Aalsters Stedelijk Ziekenhuis, 9300 Aalst, Belgium
Department of Pediatric Gastroenterology, Hepatology and Nutrition, La Fe University Hospital, 46026 Valencia, Spain
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
Author to whom correspondence should be addressed.
Nutrients 2020, 12(2), 438;
Received: 7 January 2020 / Revised: 6 February 2020 / Accepted: 7 February 2020 / Published: 9 February 2020
(This article belongs to the Special Issue Nutrition and Pediatric Gastroenterology )
The Cow’s Milk-related Symptom Score (CoMiSSTM) was created as an awareness tool for cow’s milk allergy. The aim of the present study was to analyze the inter-rater variability between a pediatrician, parents, and day to day variability. A Health Care Professional (HCP) and parent filled in the CoMiSS independently and blinded for each other to evaluate inter-rater variability. In order to validate day-to-day variability, a parent filled in the CoMiSS during 3 consecutive days and was compared to the CoMiSS scored by the HCP. The absolute agreement between parent and HCP was 75%, and 92.6% and 100% with a tolerance of 0, 1, and 2 points, respectively, resulting in excellent agreement with an intraclass correlation coefficient (ICC) 0.981 (95% Confidence Interval 0.974–0.986, p < 0.001). Day-to-day variability during 3 consecutive days resulted in an absolute agreement of 30%, increasing to 80% and 88.6% when 2 and 3 points, respectively, were accepted. The ICC was excellent for the parental prospective scores (0.93, 95% CI 0.90–0.96; p < 0.001). Day-to-day variability indicates that CoMiSS has a moderate inter-rater reliability. A very low variability was observed when scored prospectively over three days. Data suggest that the CoMiSS can reliably be scored by parents without additional training. View Full-Text
Keywords: Cow’s Milk-related Symptom Score; CoMiSS; infant Cow’s Milk-related Symptom Score; CoMiSS; infant
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Vandenplas, Y.; Carvajal, E.; Peeters, S.; Balduck, N.; Jaddioui, Y.; Ribes-Koninckx, C.; Huysentruyt, K. The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability. Nutrients 2020, 12, 438.

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