title: Comparison of clinical and biochemical markers of dehydration with the clinical dehydration scale in children: a case comparison trial.
abstract: BACKGROUND
  The clinical dehydration scale (CDS) is a quick, easy-to-use tool with 4 clinical items and a score of 1-8 that serves to classify dehydration in children with gastroenteritis as no, some or moderate/severe dehydration. Studies validating the CDS (Friedman JN) with a comparison group remain elusive. We hypothesized that the CDS correlates with a wide spectrum of established markers of dehydration, making it an appropriate and easy-to-use clinical tool.
  
  
  METHODS
  This study was designed as a prospective double-cohort trial in a single tertiary care center. Children with diarrhea and vomiting, who clinically required intravenous fluids for rehydration, were compared with minor trauma patients who required intravenous needling for conscious sedation. We compared the CDS with clinical and urinary markers (urinary electrolytes, proteins, ratios and fractional excretions) for dehydration in both groups using receiver operating characteristic (ROC) curves to determine the area under the curve (AUC).
  
  
  RESULTS
  We enrolled 73 children (male = 36) in the dehydration group and 143 (male = 105) in the comparison group. Median age was 32 months (range 3-214) in the dehydration and 96 months (range 2.6-214 months, p < 0.0001) in the trauma group. Median CDS was 3 (range 0-8) within the dehydration group and 0 in the comparison group (p < 0.0001). The following parameters were statistically significant (p < 0.05) between the comparison group and the dehydrated group: difference in heart rate, diastolic blood pressure, urine sodium/potassium ratio, urine sodium, fractional sodium excretion, serum bicarbonate, and creatinine measurements. The best markers for dehydration were urine Na and serum bicarbonate (ROC AUC = 0.798 and 0.821, respectively). CDS was most closely correlated with serum bicarbonate (Pearson r = -0.3696, p = 0.002).
  
  
  CONCLUSIONS
  Although serum bicarbonate is not the gold standard for dehydration, this study provides further evidence for the usefulness of the CDS as a dehydration marker in children.
  
  
  BACKGROUND
  Registered at ClinicalTrials.gov (NCT00462527) on April 18, 2007.
authors.forename: Ron K
authors.initials: RK
authors.lastname: Tam
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
authors.forename: Amy
authors.initials: A
authors.lastname: Plint
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lepage
authors.affiliation: Department of Pediatrics, Western University, 800 Commissioners Road East, London, ON N6A 5W9, Canada. guido.filler@lhsc.on.ca.
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
mesh_terms: D000293:Adolescent; D001639:Bicarbonates / Q000652:urine*; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D003681:Dehydration / Q000175:diagnosis* / Q000209:etiology / Q000652:urine*; D005260:Female; D005440:Fluid Therapy; D005759:Gastroenteritis / Q000150:complications; D006339:Heart Rate; D006801:Humans; D007223:Infant; D008297:Male; D011188:Potassium / Q000652:urine; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D012964:Sodium / Q000652:urine*
chemical_list: D001639:Bicarbonates; D015415:Biomarkers; D012964:Sodium; D003404:Creatinine; D011188:Potassium