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2015 ; 69
(1
): 10-2
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Performance of clinical signs in the diagnosis of dehydration in children with
acute gastroenteritis
#MMPMID25870468
Hoxha T
; Xhelili L
; Azemi M
; Avdiu M
; Ismaili-Jaha V
; Efendija-Beqa U
; Grajcevci-Uka V
Med Arch
2015[Feb]; 69
(1
): 10-2
PMID25870468
show ga
BACKGROUND: Acute evaluation and treatment of children presenting with
dehydration represent one of the most common situation in the pediatric emergency
department. To identify dehydration in infants and children before treatment, a
number of symptoms and clinical signs have been evaluated. The aim of the study
was to describe the performance of clinical signs in detecting dehydration in
children. METHODS: Two hundred children aged 1 month to 5 year were involved in
our prospective study. The clinical assessment consisted of the ten clinical
signs of dehydration, including those recommended by WHO (World Health
Organization), heart rate, and capillary refill time. RESULTS: Two hundred
patients with diarrhea were enrolled in the study. The mean age was 15.62±9.03
months and 57.5% were male. Of these 121 had a fluid deficit of < 5%, 68 had a
deficit of 5 to 9% and 11(5.5%) had a deficit of 10% or more. Patients classified
as having no or mild, moderate, and severe dehydration were found to have the
following respective gains in percent weight at the end of illness: 2.44±0.3,
6.05± 1.01 and, 10.66± 0.28, respectively. All clinical signs were found more
frequently with increasing amounts of dehydration(p<0.001, One-way ANOVA). The
median number of findings among subjects with no or mild dehydration (deficit
<5%) was 3; among those with moderate dehydration (deficit 5% to 9%) was 6.5 and
among those with severe dehydration (deficit >10%) the median was 9 (p<0.0001,
Kruskal-Wallis test). Using stepwise linear regression and a p value of <0.05 for
entry into the model, a four-variable model including sunken eyes, skin
elasticity, week radial pulse, and general appearance was derived. CONCLUSION:
None of the 10 findings studied, is sufficiently accurate to be used in
isolation. When considered together, sunken eyes, decreased skin turgor, weak
pulse and general appearance provide the best explanatory power of the physical
signs considered.