Valeur des données anamnestiques, cliniques et biologiques pour le diagnostic de déshydratation par diarrhée aiguë chez l’enfant de moins de 5 ans

Pruvost, I.; Dubos, François; Aurel, M.; Hue, V.; Martinot, A.

doi:10.1016/j.lpm.2007.10.014

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…As such, we assume the ED discharge weight and the hospital discharge weight reflect the pre-illness weight. While recent research has found post-rehydration weight correlates almost perfectly with pre-illness weight, one study demonstrated that post-rehydration weight tends to underestimate pre-illness weight [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study

et al. 2014

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BackgroundPrior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department.MethodsWe prospectively enrolled a non-consecutive cohort of children ≤18 years old. Patient weight, ultrasound measurements of the IVC and Ao, and physician gestalt were recorded. The percent weight change from presentation to discharge was used to calculate the degree of dehydration. A weight change of ≥5% was considered clinically significant dehydration. Receiver operating characteristic (ROC) curves were constructed for each of the ultrasound measurements and physician gestalt. Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater. Intra-class correlation coefficients were calculated to assess the degree of inter-rater reliability between ultrasound observers.ResultsOf 113 patients, 10.6% had significant dehydration. The IVC/Ao ratio had an area under the ROC curve (AUC) of 0.72 (95% CI 0.53 to 0.91) and, with a cutoff of 0.8, produced a SN of 67% and a SP of 71% for the diagnosis of significant dehydration. The IVC collapsibility index of 50% had an AUC of 0.58 (95% CI 0.44 to 0.72) and, with a cutoff of 80% collapsibility, produced a SN of 83% and a SP of 42%. The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility. Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.ConclusionsThe ultrasound-measured IVC/Ao ratio is a modest predictor of significant dehydration in children. The inspiratory IVC collapse and physician gestalt were poor predictors of the actual level of dehydration in this study.

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Section: Discussionmentioning

confidence: 99%

The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study

et al. 2014

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“…Gorelick, et al found their 10-point scale to have a sensitivity of 82% and specificity of 90% for predicting severe dehydration in children when assessed by an experienced emergency nurse, while Vega, et al found their 9-point scale to have a sensitivity of 70% and specificity of 84% for predicting severe dehydration when performed by an emergency physician. The Clinical Dehydration Scale was initially derived in a population of children presenting with diarrhea to a Canadian pediatric referral hospital and found to be a significant predictor of moderate-severe dehydration in that same population of children [9], [23]. Additional studies have found the Clinical Dehydration Scale to be a significant predictor of emergency department length of stay, treatment with intravenous fluids, and hospitalization, but not severity of dehydration [14], [15].…”

Section: Discussionmentioning

confidence: 99%

“…In the derivation of the Gorelick scale, serial weights were measured until a stable weight, defined as a difference <2% between the last 2 weights, was achieved [10]. Furthermore, while recent research has found post-rehydration weight correlates almost perfectly with pre-illness weight, post-rehydration weight does tend to underestimate pre-illness weight by about 2% [23]. It is also theoretically possible that children received an unnecessarily large amount of fluids making their post-rehydration weight a reflection of fluid over load rather than true baseline weight of the patient.…”

Section: Discussionmentioning

confidence: 99%

External Validation and Comparison of Three Pediatric Clinical Dehydration Scales

et al. 2014

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ObjectiveTo prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration.MethodsWe prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC) curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve.ResultsWe approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS) and Gorelick scales both had an area under the ROC curve (AUC) statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84) and 0.71 (95% CI 0.57, 0.85) respectively. The World Health Organization (WHO) scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77) and 0.61 (0.44, 0.78) respectively, which were not statistically significant.ConclusionThe Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.

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“…symptoms, however, to predict severe dehydration in the pediatric emergency department is considered suboptimal (11)(12)(13)(14). Similarly, laboratory parameters have limited diagnostic value for detecting the degree of dehydration (15).…”

Section: What Is Newmentioning

confidence: 99%

“…Popular clinical scales such as the world health organization (WHO) scale, the Gorelick scale and clinical dehydration scale have been studied in many reports. The ability of clinical signs and symptoms, however, to predict severe dehydration in the pediatric emergency department is considered suboptimal (11–14). Similarly, laboratory parameters have limited diagnostic value for detecting the degree of dehydration (15).…”

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confidence: 99%