Original Article
Development of a clinical dehydration scale for use in children between 1 and 36 months of age

https://doi.org/10.1016/j.jpeds.2004.05.035Get rights and content

Abstract

Objective

To develop a clinical dehydration scale for use in children <3 years of age.

Study design

Prospective cohort study of children between 1 and 36 months of age who presented to a tertiary pediatric emergency department (ED) with gastroenteritis. Children were weighed and scored for 12 clinical signs, were rehydrated, and then were reweighed and rescored when rehydration was completed. Weight change from pre- to post-rehydration was used to assess criterion validity with independent global assessments of dehydration severity by attending physicians and nurses as measures of construct validity. Formal approaches to item selection and reduction, reliability, discriminatory power, validity, and responsiveness were used.

Results

137 children (median age: 18 months) with gastroenteritis were studied. The final dehydration scale consisted of four clinical characteristics: general appearance, eyes, mucous membranes, and tears. The measurement properties were as follows: validity as assessed by Pearson's correlation coefficient was 0.36 to 0.57; reliability as assessed by the intra-class correlation coefficient was 0.77; discriminatory power as assessed by Ferguson's δ was 0.83; and responsiveness to change as assessed by Wilcoxon signed rank test was significant at P < .01.

Conclusion

Clinicians and researchers may consider this four-item, 8-point rating scale, developed using formal measurement methodology, as an alternative to scales developed ad hoc.

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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    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.

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