title: The value of body weight measurement to assess dehydration in children.
abstract: Dehydration secondary to gastroenteritis is one of the most common reasons for office visits and hospital admissions. The indicator most commonly used to estimate dehydration status is acute weight loss. Post-illness weight gain is considered as the gold-standard to determine the true level of dehydration and is widely used to estimate weight loss in research. To determine the value of post-illness weight gain as a gold standard for acute dehydration, we conducted a prospective cohort study in which 293 children, aged 1 month to 2 years, with acute diarrhea were followed for 7 days during a 3-year period. The main outcome measures were an accurate pre-illness weight (if available within 8 days before the diarrhea), post-illness weight, and theoretical weight (predicted from the child's individual growth chart). Post-illness weight was measured for 231 (79%) and both theoretical and post-illness weights were obtained for 111 (39%). Only 62 (21%) had an accurate pre-illness weight. The correlation between post-illness and theoretical weight was excellent (0.978), but bootstrapped linear regression analysis showed that post-illness weight underestimated theoretical weight by 0.48 kg (95% CI: 0.06-0.79, p<0.02). The mean difference in the fluid deficit calculated was 4.0% of body weight (95% CI: 3.2-4.7, p<0.0001). Theoretical weight overestimated accurate pre-illness weight by 0.21 kg (95% CI: 0.08-0.34, p = 0.002). Post-illness weight underestimated pre-illness weight by 0.19 kg (95% CI: 0.03-0.36, p = 0.02). The prevalence of 5% dehydration according to post-illness weight (21%) was significantly lower than the prevalence estimated by either theoretical weight (60%) or clinical assessment (66%, p<0.0001).These data suggest that post-illness weight is of little value as a gold standard to determine the true level of dehydration. The performance of dehydration signs or scales determined by using post-illness weight as a gold standard has to be reconsidered.
authors: Univ Lille Nord de France, UDSL, Lille, France.
authors: Isabelle
authors: I
authors: Pruvost
authors: François
authors: F
authors: Dubos
authors: Emmanuel
authors: E
authors: Chazard
authors: Valérie
authors: V
authors: Hue
authors: Alain
authors: A
authors: Duhamel
authors: Alain
authors: A
authors: Martinot
mesh_terms: D001835:Body Weight; D002675:Child, Preschool; D003681:Dehydration / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012016:Reference Values; D015430:Weight Gain
references: J Paediatr Child Health. 2002 Jun;38(3):226-8
references: 12047687
references: Emerg Infect Dis. 2003 May;9(5):565-72
references: 12737740
references: JAMA. 2004 Jun 9;291(22):2746-54
references: 15187057
references: PLoS Med. 2007 Oct 16;4(10):e296
references: 17941714
references: Pediatr Emerg Care. 1997 Jun;13(3):179-82
references: 9220501
references: Lancet. 1989 Sep 9;2(8663):605-7
references: 2570294
references: J Pediatr Gastroenterol Nutr. 2008 May;46 Suppl 2:S81-122
references: 18460974
references: Pediatr Infect Dis J. 2006 Jan;25(1 Suppl):S7-S11
references: 16397431
references: Am J Dis Child. 1991 Mar;145(3):296-8
references: 2003478
references: J Pediatr Gastroenterol Nutr. 1996 Jan;22(1):56-61
references: 8788288
references: Pediatrics. 1997 May;99(5):E6
references: 9113963
references: Lancet. 1986 Feb 8;1(8476):307-10
references: 2868172
references: Ann Emerg Med. 2003 Feb;41(2):196-205
references: 12548269
references: Clin Pediatr (Phila). 1997 Jul;36(7):395-400
references: 9241476
references: Stat Med. 2000 May 15;19(9):1141-64
references: 10797513
references: J Pediatr. 2004 Aug;145(2):201-7
references: 15289767
references: J Pediatr. 1991 Apr;118(4 Pt 2):S27-33
references: 2007954