Ultrasound Assessment of Severe Dehydration in Children With Diarrhea and Vomiting

作者：Levine Adam C^*; Shah Sachita P; Umulisa Irenee; Munyaneza Richard B Mark; Dushimiyimana Jean Marie; Stegmann Katrina; Musavuli Juvenal; Ngabitsinze Protogene; Stulac Sara; Epino Henry M; Noble Vicki E

来源：ACADEMIC EMERGENCY MEDICINE, 2010, 17(10): 1035-1041.

DOI：10.1111/j.1553-2712.2010.00830.x

• gastroenteritis
• diarrhea
• pediatrics
• dehydration
• ultrasonography

Objectives:
The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale).
Methods:
The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard.
Results:
Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale.
Conclusions:
Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management.

• 出版日期2010-10