Abstract
BackgroundDehydration due to acute gastroenteritis is one of the leading causes of mortality in children worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate percentage dehydration in children with gastroenteritis based on clinical signs. Of these, only the CDS has been prospectively validated against a valid gold standard, though never in low- and middle-income countries. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status in children when performed by nurses or general physicians in a low-income country.MethodsWe prospectively enrolled a non-consecutive sample of children presenting to three Rwandan hospitals with diarrhea and/or vomiting. A health care provider documented clinical signs on arrival and weighed the patient using a standard scale. Once admitted, the patient received rehydration according to standard hospital protocol and was weighed again at hospital discharge. Receiver operating characteristic (ROC) curves were created for each of the three scales compared to the gold standard, percent weight change with rehydration. Sensitivity, specificity, and likelihood ratios were calculated based on the best cutoff points of the ROC curves.ResultsWe enrolled 73 children, and 49 children met eligibility criteria. Based on our gold standard, the children had a mean percent dehydration of 5% on arrival. The WHO scale, Gorelick scale, and CDS did not have an area under the ROC curve statistically different from the reference line. The WHO scale had sensitivities of 79% and 50% and specificities of 43% and 61% for severe and moderate dehydration, respectively; the 4- and 10-point Gorelick scale had sensitivities of 64% and 21% and specificities of 69% and 89%, respectively, for severe dehydration, while the same scales had sensitivities of 68% and 82% and specificities of 41% and 35% for moderate dehydration; the CDS had a sensitivity of 68% and specificity of 45% for moderate dehydration.ConclusionIn this sample of children, the WHO scale, Gorelick scale, and CDS did not provide an accurate assessment of dehydration status when used by general physicians and nurses in a developing world setting.
Highlights
Dehydration due to acute gastroenteritis is one of the leading causes of mortality in children worldwide
Enrollment occurred MarchJuly 2009, and included all pediatric patients presenting with diarrhea and/or vomiting on weekdays from 7:00 a. m. - 5:00 p.m., and occasional nights and weekends based on availability of study staff
Two children died prior to discharge, 12 children had evidence of severe malnutrition, and 7 children were missing discharge weights, leaving 52 children for analysis. Of these 52 children, 49 children were between 1 month and 5 years old and could be classified by the Gorelick and World Health Organization (WHO) scale, while 48 children were between 1 month and 3 years old and could be classified by the Clinical Dehydration Scale (CDS)
Summary
Dehydration due to acute gastroenteritis is one of the leading causes of mortality in children worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate percentage dehydration in children with gastroenteritis based on clinical signs. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status in children when performed by nurses or general physicians in a low-income country. In order to apply the most appropriate treatment for dehydration in children with gastroenteritis, healthcare providers must first accurately assess the severity of dehydration [5]. Several organizations and research institutions have developed scales to estimate dehydration status using clinical signs. The scales predict percent dehydration for slightly different age groups; the CDS is for children between 1 month and 3 years, while the other two scales are for children between 1 month and 5 years. Each scale predicts a slightly different range for percent volume loss
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