External validation and comparison of three pediatric clinical dehydration scales.
OBJECTIVE
To prospectively validate three popular clinical dehydration scales and overall physician gestalt in children with vomiting or diarrhea relative to the criterion standard of percent weight change with rehydration.


METHODS
We prospectively enrolled a non-consecutive cohort of children ≤ 18 years of age with an acute episode of diarrhea or vomiting. Patient weight, clinical scale variables and physician clinical impression, or gestalt, were recorded before and after fluid resuscitation in the emergency department and upon hospital discharge. The percent weight change from presentation to discharge was used to calculate the degree of dehydration, with a weight change of ≥ 5% considered significant dehydration. Receiver operating characteristics (ROC) curves were constructed for each of the three clinical scales and physician gestalt. Sensitivity and specificity were calculated based on the best cut-points of the ROC curve.


RESULTS
We approached 209 patients, and of those, 148 were enrolled and 113 patients had complete data for analysis. Of these, 10.6% had significant dehydration based on our criterion standard. The Clinical Dehydration Scale (CDS) and Gorelick scales both had an area under the ROC curve (AUC) statistically different from the reference line with AUCs of 0.72 (95% CI 0.60, 0.84) and 0.71 (95% CI 0.57, 0.85) respectively. The World Health Organization (WHO) scale and physician gestalt had AUCs of 0.61 (95% CI 0.45, 0.77) and 0.61 (0.44, 0.78) respectively, which were not statistically significant.


CONCLUSIONS
The Gorelick scale and Clinical Dehydration Scale were fair predictors of dehydration in children with diarrhea or vomiting. The World Health Organization scale and physician gestalt were not helpful predictors of dehydration in our cohort.
Warren Alpert Medical School Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America; Division of Emergency Medicine, University of Washington, Seattle, Washington, United States of America.
Joshua
J
Jauregui
Warren Alpert Medical School Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America.
Daniel
D
Nelson
Warren Alpert Medical School Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America.
Esther
E
Choo
Rhode Island Hospital, Providence, Rhode Island, United States of America.
Branden
B
Stearns
Warren Alpert Medical School Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America.
Adam C
AC
Levine
Warren Alpert Medical School Department of Emergency Medicine, Brown University, Providence, Rhode Island, United States of America.
Otto
O
Liebmann
Rhode Island Hospital, Providence, Rhode Island, United States of America.
Sachita P
SP
Shah
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003681:Dehydration / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D005863:Gestalt Theory; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D014944:World Health Organization