Abstract
Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions. The indicator most commonly used to estimate dehydration status is acute weight loss. Post-illness weight gain is considered as the gold-standard to determine the true level of dehydration and is widely used to estimate weight loss in research. To determine the value of post-illness weight gain as a gold standard for acute dehydration, we conducted a prospective cohort study in which 293 children, aged 1 month to 2 years, with acute diarrhea were followed for 7 days during a 3-year period. The main outcome measures were an accurate pre-illness weight (if available within 8 days before the diarrhea), post-illness weight, and theoretical weight (predicted from the child’s individual growth chart). Post-illness weight was measured for 231 (79%) and both theoretical and post-illness weights were obtained for 111 (39%). Only 62 (21%) had an accurate pre-illness weight. The correlation between post-illness and theoretical weight was excellent (0.978), but bootstrapped linear regression analysis showed that post-illness weight underestimated theoretical weight by 0.48 kg (95% CI: 0.06–0.79, p<0.02). The mean difference in the fluid deficit calculated was 4.0% of body weight (95% CI: 3.2–4.7, p<0.0001). Theoretical weight overestimated accurate pre-illness weight by 0.21 kg (95% CI: 0.08–0.34, p = 0.002). Post-illness weight underestimated pre-illness weight by 0.19 kg (95% CI: 0.03–0.36, p = 0.02). The prevalence of 5% dehydration according to post-illness weight (21%) was significantly lower than the prevalence estimated by either theoretical weight (60%) or clinical assessment (66%, p<0.0001).These data suggest that post-illness weight is of little value as a gold standard to determine the true level of dehydration. The performance of dehydration signs or scales determined by using post-illness weight as a gold standard has to be reconsidered.
Highlights
Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions in developed countries [1,2,3]
Theoretical weight could be measured for only 46% (n = 134) of the patients, because 41% (n = 119) of patients had been brought to the Emergency Department (ED) without child health passports, and 14% (n = 40) did not have valid growth charts to determine the theoretical weight as defined in the methods
The mean absolute difference between fluid deficit calculated from the theoretical weight and that calculated from the post-illness weight was 4% of body weight
Summary
Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions in developed countries [1,2,3]. Among European children ,3 years of age, incidence of diarrhea ranges from 0.5 to 1.9 episodes per child per year [4]. The management of acute diarrhea in children is largely based on clinical examination which allows assessment of hydration status. Dehydration is difficult to diagnose clinically [5]. Combinations of examination signs perform markedly better than any individual sign in predicting dehydration [6]. Many scores have been developed to estimate dehydration, but only one, the Clinical Dehydration Scale, has been validated to predict a longer length of Emergency Department (ED) stay and the need for intravenous fluid rehydration [7]
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