Development of a clinical dehydration scale for use in children between 1 and 36 months of age.
OBJECTIVE
To develop a clinical dehydration scale for use in children <3 years of age.


METHODS
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 delta was 0.83; and responsiveness to change as assessed by Wilcoxon signed rank test was significant at P <.01.


CONCLUSIONS
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.
Division of Pediatric Medicine, Department of Pediatrics, University of Toronto Faculty of Medicine and the Hospital for Sick Children, Toronto, Ontario, Canada.
Jeremy N
JN
Friedman
Ran D
RD
Goldman
Rajendu
R
Srivastava
Patricia C
PC
Parkin
D002675:Child, Preschool; D015331:Cohort Studies; D003681:Dehydration / Q000175:diagnosis* / Q000209:etiology; D003938:Diagnostic Techniques, Digestive System; D005260:Female; D005759:Gastroenteritis / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies