External Validation of the DHAKA Score for Diagnosing Severe Dehydration in Children with Acute Diarrhea in Resource‐limited Settings

Abstract

BackgroundAcute diarrhea remains both common and deadly in children worldwide. Proper treatment depends on accurately assessing dehydration status. Current World Health Organization (WHO) guidelines include an algorithm for classifying children as having no, some, or severe dehydration, which has never been properly validated. The Dehydration: Assessing Kids Accurately (DHAKA) study recently derived a new scoring system for dehydration in children, but it requires external validation.MethodsOur study enrolled a random sample of children with acute diarrhea in Bangladesh. Local nurses prospectively applied both the DHAKA score and the WHO algorithm to children on arrival and obtained serial weights as they were rehydrated. The percent weight change with rehydration was used to classify subjects with severe (>9%) dehydration, some (3%–9%) dehydration, or no (<3%) dehydration. Test characteristics and the area under receiver operator characteristic curves (AUC) were calculated and compared for both diagnostic tools.ResultsA total of 546 children were enrolled, with 488 included in the final analysis. The DHAKA score had an AUC of 0.77 compared to 0.72 for the WHO algorithm for the diagnosis of severe dehydration (p = 0.001) and 0.84 compared to 0.62 for the diagnosis of any dehydration (p < 0.001). The DHAKA score had a sensitivity of 86% and specificity of 54% for diagnosing severe dehydration and 93 and 50% for diagnosing any dehydration.ConclusionThe DHAKA score is now the first dehydration assessment tool both derived and validated in resource‐limited settings, and it outperformed the WHO algorithm. Frontline providers may use this new tool to better manage acute diarrhea in children.DHAKA score.image

Ultrasound Adds No Benefit to Clinical Exam for Predicting Dehydration in Children With Acute Diarrhea in a Resource‐Limited Setting

“…The DHAKA score was the first empirically derived and externally validated model for assessing dehydration in children with acute diarrhea in a lowresource setting. 9,16 The score was designed to be used by nurses in resource-limited settings to quickly determine a child's degree of dehydration based on clinical signs and symptoms and was shown to be both more accurate and reliable than the Integration Management of Childhood Illness algorithm in a limited-resource setting. 9 Recent research has also shown the promise of sonographic measurements as a predictor of diarrheal dehydration.…”

“…9 The DHAKA score, which uses a combination of several signs and symptoms, was the first clinical diagnostic tool for assessing dehydration to be externally validated in a resource-limited setting, where it outperformed the WHO algorithm. 9 In addition to clinical symptoms, recent research has identified sonographic measurement of the ratio of aorta-to-inferior vena cava diameter (Ao/IVC) to be a moderately accurate assessor of dehydration in children. [10][11][12][13] The DHAKA study also looked at sonographic measurement of the Ao/IVC ratio as a predictor of dehydration.…”

“…[6][7][8] The Dehydration: Assessing Kids Accurately (DHAKA) study derived a new clinical diagnostic model for assessing dehydration in children with acute diarrhea in resource-limited settings. 9 The DHAKA score, which uses a combination of several signs and symptoms, was the first clinical diagnostic tool for assessing dehydration to be externally validated in a resource-limited setting, where it outperformed the WHO algorithm. 9 In addition to clinical symptoms, recent research has identified sonographic measurement of the ratio of aorta-to-inferior vena cava diameter (Ao/IVC) to be a moderately accurate assessor of dehydration in children.…”

“…Studies have shown that commonly used scales such as the World Health Organization (WHO) Integration Management of Childhood Illness algorithm, the Gorelick Scale, and the Clinical Dehydration Scale, are not able to accurately assess dehydration in children in resource‐limited settings . The Dehydration: Assessing Kids Accurately (DHAKA) study derived a new clinical diagnostic model for assessing dehydration in children with acute diarrhea in resource‐limited settings . The DHAKA score, which uses a combination of several signs and symptoms, was the first clinical diagnostic tool for assessing dehydration to be externally validated in a resource‐limited setting, where it outperformed the WHO algorithm …”

“…The Dehydration: Assessing Kids Accurately (DHAKA) study derived a new clinical diagnostic model for assessing dehydration in children with acute diarrhea in resource‐limited settings . The DHAKA score, which uses a combination of several signs and symptoms, was the first clinical diagnostic tool for assessing dehydration to be externally validated in a resource‐limited setting, where it outperformed the WHO algorithm …”