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Diagnostic accuracy of clinical dehydration scales in children

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Abstract

The aim of this study was to evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the World Health Organization (WHO) scale, and the Gorelick scale for dehydration assessment in children. A prospective, observational study was carried out between October 2014 and December 2016. Eligible participants were children aged 1 month to 5 years with acute diarrhea. After hospital admission, each patient’s weight was recorded and the degree of dehydration based on three scales was assessed. The reference standard was the percentage weight change between the discharge and admission weights. The main outcomes were the sensitivity, specificity, positive likelihood ratio (LR), and negative LR. Of 128 children enrolled in the study, complete data were available from 118 patients for analysis. Most of children presented with no or mild dehydration. Only the CDS showed limited value in confirming a diagnosis of dehydration ≥6% (positive LR 3.9, 95% CI 1.1 to 9.1), with no value in ruling it out (negative LR 0.6, 95% CI 0.2 to 0.99).

Conclusion: In our cohort, the CDS was of limited diagnostic value in ruling in severe dehydration in children with acute gastroenteritis. The WHO and Gorelick scales were not helpful in the assessment of dehydration.

What is Known :

• Treatment of acute gastroenteritis (AGE) is based on assessing and correcting the degree of dehydration.

• Several scales combining various signs and symptoms have been developed, including the Clinical Dehydration Scale (CDS), and the World Health Organization (WHO) scale, and the Gorelick scale. None of these scales is internationally accepted for best accuracy in diagnosing dehydration in children.

What is New:

• The CDS was of limited diagnostic value in ruling in severe dehydration in children with AGE.

• The WHO and Gorelick scales were not helpful in the assessment of dehydration.

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Abbreviations

AGE:

Acute gastroenteritis

CDS:

Clinical Dehydration Scale

CI:

Confidence interval

LR:

Likelihood ratio

WHO:

World Health Organization

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Authors and Affiliations

  1. Department of Paediatrics, The Medical University of Warsaw, Zwirki i Wigury 63A, 02-091, Warsaw, Poland

    Anna Falszewska, Piotr Dziechciarz & Hania Szajewska

Authors
  1. Anna Falszewska
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  2. Piotr Dziechciarz
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  3. Hania Szajewska
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Contributions

All authors contributed to the study protocol. AF was responsible for data collection, data analysis, data interpretation, and preparation of the report. AF assumed the main responsibility for the writing of the first draft of this manuscript. All authors contributed to (and agreed upon) the final version.

Corresponding author

Correspondence to Hania Szajewska.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The study was funded by the Medical University of Warsaw.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Peter de Winter

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Falszewska, A., Dziechciarz, P. & Szajewska, H. Diagnostic accuracy of clinical dehydration scales in children. Eur J Pediatr 176, 1021–1026 (2017). https://doi.org/10.1007/s00431-017-2942-8

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  • DOI: https://doi.org/10.1007/s00431-017-2942-8

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