title: Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis.
abstract: OBJECTIVE
  To determine the most accurate, noninvasive method of assessing dehydration.
  
  
  METHODS
  The following data sources were searched: electronic databases, gray literature, scientific meetings, reference lists, and authors of unpublished studies. Eligible studies were comparative outpatient evaluations that used an accepted reference standard and were conducted in developed countries in children aged <18 years with gastroenteritis. Data extraction was completed independently by multiple reviewers before a consensus was made.
  
  
  RESULTS
  Nine studies that included 1039 participants were identified. The 4-item Clinical Dehydration Scale (CDS), the "Gorelick" score, and unstructured physician assessment were evaluated in 3, 2, and 5 studies, respectively. Bedside ultrasound, capillary digital videography, and urinary measurements were each evaluated in one study. The CDS had a positive likelihood ratio (LR) range of 1.87-11.79 and a negative LR range of 0.30-0.71 to predict 6% dehydration. When combined with the 4-item Gorelick Score, the positive LR was 1.93 (95% CI 1.07-3.49) and negative LR was of 0.40 (95% CI 0.24-0.68). Unstructured dehydration assessment had a pooled positive LR of 2.13 (95% CI 1.33-3.44) and negative LR of 0.48 (95% CI 0.28-0.82) to detect ≥ 5% dehydration.
  
  
  CONCLUSIONS
  Overall, the clinical scales evaluated provide some improved diagnostic accuracy. However, test characteristics indicate that their ability to identify children both with and without dehydration is suboptimal. Current evidence does not support the routine use of ultrasound or urinalysis to determine dehydration severity.
authors: Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
authors: Stephen B
authors: SB
authors: Freedman
authors: Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: Ben
authors: B
authors: Vandermeer
authors: Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: Andrea
authors: A
authors: Milne
authors: Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
authors: Lisa
authors: L
authors: Hartling
mesh_terms: D002648:Child; D003681:Dehydration / Q000175:diagnosis* / Q000209:etiology; D003938:Diagnostic Techniques, Digestive System; D005759:Gastroenteritis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D015203:Reproducibility of Results