Ultrasound Assessment of Severe Dehydration in Children With Diarrhea and Vomiting

Abstract

Objectives: The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale). Methods:The authors enrolled a prospective cohort of children presenting with diarrhea and ⁄ or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluidresuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard.Results: Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta ⁄ IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta ⁄ IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale.Conclusions: Ultrasound of the aorta ⁄ IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management.

Sonographic aorta/IVC cross-sectional area index for evaluation of dehydration in children

“…In a study of 73 children aged under 15 years with acute diarrhea, the aorta-to-IVC ratio had an AUC of 0.76 (95% CI = 0.62-0.90) for the prediction of severe dehydration, with a sensitivity of 93% and specificity of 59% [7]. In a study of 112 patients under 18 years of age, the IVC-to-aorta ratio predicted significant (N 5%) dehydration with an AUC of 0.73 (95% CI = 0.61-0.84) and a sensitivity of 86% and specificity of 51% at the best cut-point of 0.8 [5].…”

“…Several studies have identified ultrasound of the inferior vena cava (IVC) and the aorta-to-IVC ratio as a means to identify dehydration in children [3][4][5][6][7]. However, recent studies and a systematic review did not find sufficient evidence to encourage the use of ultrasound for assessment of dehydration in children [2,8].…”

Applications of ultrasound in the low and middle income countries

“…Given the prevalence of poverty-related diseases, such as tuberculosis, malaria and dehydration due to diarrheal illness, in the developing world, it is no surprise that emerging uses for ultrasound in LMICs include these diseases. 5 We summarize here, by region, some of the highlights of diagnostic ultrasound research for specific diseases in resource-limited settings in LMICs. …”

Point-of-Care Ultrasound for Pediatric Shock

“…[21][22][23] Few studies exist in the pediatric literature, and there is some conflicting evidence as to its utility in estimating of volume status. [24][25][26] A recent study by Ng et al 24 found that IVC measurements did not correlate well with CVP measurements in a study of patients in the pediatric critical care unit, although two thirds of these patients were mechanically ventilated.…”