The value of parental report for diagnosis and management of dehydration in the emergency department.
OBJECTIVE
We define the predictive value of parents' computer-based report for history and physical signs of dehydration for a primary outcome of percentage of dehydration (fluid deficit) and 2 secondary outcomes: clinically important acidosis and hospital admission. We also sought to compare the reports of physical signs related to dehydration made by parents and nurses.


METHODS
We performed a prospective observational trial in an urban pediatric emergency department. A convenience sample of parents completed a computer-based interview covering historical details and physical signs (ill appearance, sunken fontanelle, sunken eyes, decreased tears, dry mouth, cool extremities, and weak cry) related to dehydration. Nurses independently completed an assessment of physical signs for enrolled children. The primary outcome was the degree of dehydration (fluid deficit), which was defined as the percentage difference between initial ED weight and stable final weight after the illness. Secondary outcomes included clinically important acidosis (defined as a serum CO(2) value of </=15 mEq/L) and hospital admission.


RESULTS
One hundred thirty-two parent-child dyads comprised the final sample. Parent-reported data manifested higher sensitivity (range 73% to 100%) than specificity (range 0% to 49%) for the prediction of dehydration of 5% or greater. Likelihood ratios (LRs) near zero (<0.1) suggest that a normal history of fluid intake and urine output reduced the likelihood of significant dehydration. Parental report of a normal tearing state reduced the likelihood of significant dehydration and clinically important acidosis (negative LRs of 0.4 and 0.1, respectively). Two physical signs reported by parents, sunken fontanelle and decreased tears, were associated with hospital admission (positive LR of 3.4 and 4.0, respectively).


CONCLUSIONS
Parents' report of history and observations for children captured through computer-based interview demonstrates predictive value for relevant outcomes in dehydration.
Porter
Stephen C
SC
Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA. stephen.porter@tch.harvard.edu
Fleisher
Gary R
GR
Kohane
Isaac S
IS
Mandl
Kenneth D
KD
D000328:Adult; D003681:Dehydration / Q000175:diagnosis* / Q000628:therapy; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D011939:Mental Recall; D010290:Parents; D010808:Physical Examination; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013666:Tears