Original ArticleDevelopment of a clinical dehydration scale for use in children between 1 and 36 months of age☆
Section snippets
Methods
As a methodologic framework, Kirshner and Guyatt's general approach to the development of a health status index along with Streiner and Norman's textbook on health measurement scales were used.8., 9. Validity is defined as the extent to which a scale measures what it is intended to measure.9 Reliability is defined as the extent to which a scale is reproducible or consistent.9 Discriminatory power is defined as the ability of a scale to discriminate amongst subjects, ie, scores should be spread
Study population
A sample of 141 children were enrolled in the study (Table II). Of these, 94 children had electrolyte measurement ordered by the attending physician. Two patients had hyponatremia and two had hypernatremia; they were excluded, leaving 137 patients in the study. Of the 137 study patients, 94 (69%) were rehydrated intravenously and 43 (31%) were rehydrated orally; 14 (10%) were admitted to the hospital, and 123 (90%) were managed in the ED and the observation unit.
A dehydrated weight and
Discussion
In this group of 137 children with a median age of 18 months and a diagnosis of gastroenteritis, the following four items in aggregate had the most significant measurement properties for dehydration: general appearance, eyes, mucous membranes, and tears. Many clinicians currently utilize a categorical rating scale (mild, moderate, severe) to measure the severity of dehydration and to guide decision making and therapy. The measurement properties of this informally developed scale remains
Acknowledgements
We are indebted to the research nurses for their help with patient enrollment and data collection: Pauline Mathews, Audrey Bell-Peters, Jane Ciordes, and Deborah Cutler. We also thank the emergency department physicians and nurses who participated in the study.
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Cited by (136)
Severity assessment tools for dehydration associated with diarrhoea in a low-resource setting
2023, The Lancet Global HealthA systematic review of tools for predicting complications in patients with acute infectious diarrhea
2023, American Journal of Emergency MedicineCitation Excerpt :In addition, the EsVida scale is composed of more questions than the CDS, which may hinder its use in the ED where decision making must be simple and quick. In contrast, tools such as the Gorelick scale, the WHO (World Health Organization) scale and the CDS were developed to assess the dehydration but not the risk of complications per se [25-27]. A tool called the modified Vesikari scale has been developed to predict patient prognosis and healthcare needs (consultation with healthcare providers, fluid rehydration or hospitalization) based on a gastroenteritis illness severity score, but for research purposes only, not in the clinic [28].
Gastroenteritis
2022, Paediatrics and Child Health (United Kingdom)Oral Ondansetron Administration in Children Seeking Emergency Department Care for Acute Gastroenteritis: A Patient-Level Propensity-Matched Analysis
2022, Annals of Emergency MedicineCitation Excerpt :A minimum 30-minute oral rehydration window was prespecified to avoid classifying as treatment failures children for whom the initial treatment plan included the intent to administer intravenous fluids. We report the level of dehydration using the Clinical Dehydration Scale, which classifies children into 3 severity groups—no dehydration (score=0), some dehydration (scores 1 to 4), and moderate-to-severe dehydration (scores 5 to 8) (Appendix E1, available at http://www.annemergmed.com).15 Illness severity at the time of study enrollment was classified using the Modified Vesikari Scale, a composite measure that includes fever and duration and severity of vomiting and diarrhea; scores range from 0 to 20, with higher scores indicating more severe disease (Appendix E1).16,17
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Dr Jeremy N. Friedman participated in conception and design, acquisition of data, interpretation of data, drafting of the manuscript, obtaining funding, and supervision of the research team. Dr Ran Goldman and Dr Rajendu Srivastava participated in acquisition of data and revision of the manuscript. Dr Patricia C. Parkin participated in design, data analysis, interpretation of data, revision of manuscript, obtaining funding.
Supported by grants from the Hospital for Sick Children Research Institute Seed Grant, and the Physician Services Incorporated Foundation (number 00-15). The Pediatric Outcomes Research Team is supported by a grant from the Hospital for Sick Children Foundation, Toronto, Canada.