Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial

BMC Pediatrics

Guido Filler¹  Nathalie Lepage²  Amy Plint⁴  Hubert Wong³  Ron K Tam⁴ 

[1] Department of Pediatrics, Western University, 800 Commissioners Road East, London, ON N6A 5W9, Canada;Department of Pathology and Laboratory Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada;Department of Pediatrics, Rouge Valley Health Center, 2867 Ellesmere Road, Toronto, ON M1E 4B9, Canada;Departments of Pediatrics and Emergency Medicine, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada

关键词: Bicarbonate;    Microalbumin/creatinine ratio;    Cystatin C;    Dehydration;    Gastroenteritis;   

Others  :  1138773
DOI  :  10.1186/1471-2431-14-149

 received in 2014-01-22, accepted in 2014-05-30,  发布年份 2014

【 摘 要 】

Background

The clinical dehydration scale (CDS) is a quick, easy-to-use tool with 4 clinical items and a score of 1–8 that serves to classify dehydration in children with gastroenteritis as no, some or moderate/severe dehydration. Studies validating the CDS (Friedman JN) with a comparison group remain elusive. We hypothesized that the CDS correlates with a wide spectrum of established markers of dehydration, making it an appropriate and easy-to-use clinical tool.

Methods

This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions) for dehydration in both groups using receiver operating characteristic (ROC) curves to determine the area under the curve (AUC).

Results

We enrolled 73 children (male = 36) in the dehydration group and 143 (male = 105) in the comparison group. Median age was 32 months (range 3–214) in the dehydration and 96 months (range 2.6-214 months, p < 0.0001) in the trauma group. Median CDS was 3 (range 0–8) within the dehydration group and 0 in the comparison group (p < 0.0001). The following parameters were statistically significant (p < 0.05) between the comparison group and the dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002).

Conclusion

Although serum bicarbonate is not the gold standard for dehydration, this study provides further evidence for the usefulness of the CDS as a dehydration marker in children.

Trial registration

Registered at ClinicalTrials.gov (NCT00462527) on April 18, 2007.

【 授权许可】

   
2014 Tam et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Liebelt EL: Clinical and laboratory evaluation and management of children with vomiting, diarrhea, and dehydration. Curr Opin Pediatr 1998, 10(5):461-469.
• [2]Rothrock SG, Green SM, McArthur CL, DelDuca K: Detection of electrolyte abnormalities in children presenting to the emergency department: a multicenter, prospective analysis. Detection of Electrolyte Abnormalities in Children Observational National Study (DEACONS) Investigators. Acad Emerg Med 1997, 4(11):1025-1031.
• [3]Freedman SB, Steiner MJ, Chan KJ: Oral ondansetron administration in emergency departments to children with gastroenteritis: an economic analysis. PLoS Med 2010, 7(10):e1000350. doi:10.1371/journal.pmed.1000350
• [4]Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, Rudan I, Campbell H, Cibulskis R, Li M, Mathers C, Black RE, Child Health Epidemiology Reference Group of WHO and UNICEF: Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012, 379(9832):2151-2161.
• [5]Gorelick MH, Shaw KN, Murphy KO: Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics 1997, 99(5):E6.
• [6]Vega RM, Avner JR: A prospective study of the usefulness of clinical and laboratory parameters for predicting percentage of dehydration in children. Pediatr Emerg Care 1997, 13(3):179-182.
• [7]Goldman RD, Friedman JN, Parkin PC: Validation of the clinical dehydration scale for children with acute gastroenteritis. Pediatrics 2008, 122(3):545-549.
• [8]Friedman JN, Goldman RD, Srivastava R, Parkin PC: Development of a clinical dehydration scale for use in children between 1 and 36 months of age. J Pediatr 2004, 145(2):201-207.
• [9]Bailey B, Gravel J, Goldman RD, Friedman JN, Parkin PC: External validation of the clinical dehydration scale for children with acute gastroenteritis. Acad Emerg Med 2010, 17(6):583-588.
• [10]Gravel J, Manzano S, Guimont C, Lacroix L, Gervaix A, Bailey B: Multicenter validation of the clinical dehydration scale for children. Arch Pediatr 2010, 17(12):1645-1651.
• [11]Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A: A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976, 58(2):259-263.
• [12]Filler G, Lepage N: Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 2003, 18(10):981-985.
• [13]National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004, 114(2 Suppl 4th Report):555-576.
• [14]Falkner B, Daniels SR: Summary of the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Hypertension 2004, 44(4):387-388.
• [15]Wells SA Jr, Santoro M: Update: the status of clinical trials of kinase inhibitors in thyroid cancer. J Clin Endocrinol Metab 2014, 99(5):1543-1555.
• [16]Fryer JG, Karlberg J, Hayes M: An approach to the estimation of growth standards: the univariate case. Acta Paediatr Scand Suppl 1989, 350:21-36.
• [17]Winter SD: Measurement of urine electrolytes: clinical significance and methods. Crit Rev Clin Lab Sci 1981, 14(3):163-187.
• [18]Kim S, Sung J, Kang WC, Ahn SY, Kim DK, Chin HJ, Na KY, Joo KW, Chae DW, Han JS: Increased plasma osmolar gap is predictive of contrast-induced acute kidney injury. Tohoku J Exp Med 2012, 228(2):109-117.
• [19]Schneider AG, Bellomo R: Urinalysis and pre-renal acute kidney injury: time to move on. Crit Care 2013, 17(3):141.
• [20]Vanmassenhove J, Glorieux G, Hoste E, Dhondt A, Vanholder R, Van Biesen W: Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis. Crit Care 2013, 17(5):R234.
• [21]Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W: Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 2013, 28(2):254-273.
• [22]Zheng J, Xiao Y, Yao Y, Xu G, Li C, Zhang Q, Li H, Han L: Comparison of urinary biomarkers for early detection of acute kidney injury after cardiopulmonary bypass surgery in infants and young children. Pediatr Cardiol 2013, 34(4):880-886.
• [23]Fahimi D, Mohajeri S, Hajizadeh N, Madani A, Esfahani ST, Ataei N, Mohsseni P, Honarmand M: Comparison between fractional excretions of urea and sodium in children with acute kidney injury. Pediatr Nephrol 2009, 24(12):2409-2412.
• [24]Plotz FB, Bouma AB, van Wijk JA, Kneyber MC, Bokenkamp A: Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med 2008, 34(9):1713-1717.
• [25]Steiner MJ, DeWalt DA, Byerley JS: Is this child dehydrated? JAMA 2004, 291(22):2746-2754.
• [26]Teach SJ, Yates EW, Feld LG: Laboratory predictors of fluid deficit in acutely dehydrated children. Clin Pediatr 1997, 36(7):395-400.
• [27]Burkhart DM: Management of acute gastroenteritis in children. Am Fam Physician 1999, 60(9):2555-2563. 2565–2556
• [28]Ritchie RF, Ledue TB, Craig WY: Patient hydration: a major source of laboratory uncertainty. Clin Chem Lab Med 2007, 45(2):158-166.
• [29]Freedman SB, Adler M, Seshadri R, Powell EC: Oral ondansetron for gastroenteritis in a pediatric emergency department. N Engl J Med 2006, 354(16):1698-1705.