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To determine the risk factors for hospital death in children with acute gastrointestinal disease requiring hospital care. Prospective cohort study. Tertiary care children’s hospital in Canada. Consecutive sample of 2632 children (median age 27 months; interquartile range, 13-72 months) presenting with acute gastroenteritis and/or diarrheal stools with or without vomiting. None. Of the 2632 children, 413 died in hospital (15.5%). Thirty-nine of these deaths occurred within the 3 days after admission. Significant risk factors for hospital death in children with acute gastroenteritis were having another chronic illness (adjusted odds ratio, 4.56 [95% CI, 2.89-7.19]; P39.0 degrees C, suggested that the presence of shock, abnormal mental status, or hypothermia added little additional prognostic information. The strength of the association between hypoxia and pneumonia and hospital death was greatly influenced by the presence of another chronic illness in the same child. Although the combination of hypoxia and pneumonia was a relatively strong predictor of hospital death, this added little to that from pneumonia alone. The other risk factors are applicable to all children with gastroenteritis, but not all of the children in this study had these risk factors. Nonetheless, the four risk factors identified in this study can be incorporated into clinical practice and
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