title: Comparing the Accuracy of the Three Dehydration Scales in Children with Acute Diarrhea in a Developing Country of Kosovo.
abstract: BACKGROUND
  Although diarrhea is a preventable disease, it remains the second leading cause of death (after pneumonia) among children aged under five years worldwide. The World Health Organization (WHO) scale, the Gorelick scale, and the Clinical Dehydration Scale (CDS) were created to estimate dehydration status using clinical signs. The purpose of this study is to determine whether these clinical scales can accurately assess dehydration status of children in a developing country of Kosovo.
  
  
  METHODS
  Children aged 1 month to 5 years with a history of acute diarrhea were enrolled in the study. After recording the data about the patients historical features the treating physician recorded the physical examination findings consistent with each clinical score. Receiver operating characteristic (ROC) curves were constructed to evaluate the performance of the three scales, compared to the gold standard, percent weight change with rehydration. Sensitivity, specificity and likelihood ratios were calculated using the best cut-off points of the ROC curves.
  
  
  RESULTS
  We enrolled 230 children, and 200 children met eligibility criteria. The WHO scale for predicting significant dehydration (≥5 percent weight change) had an area under the curve (AUC) of 0.71 (95% : CI= 0.65-0.77). The Gorelick scales 4- and 10-point for predicting significant dehydration, had an area under the curve of 0.71 (95% : CI=0.63- 0.78) and 0.74 (95% : CI= 0.68-0.81) respectively. Only the CDS for predicting the significant dehydration above ≥6% percent weight change, did not have an area under the curve statistically different from the reference line with an AUC of 0.54 (95% CI = 0.45- 0.63).
  
  
  CONCLUSIONS
  The WHO dehydration scale and Gorelick scales were fair predictors of dehydration in children with diarrhea. Only the Clinical Dehydration Scale was found not to be a helpful predictor of dehydration in our study cohort.
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Teuta
authors.initials: T
authors.lastname: Hoxha
authors.affiliation: Department of Pediatrics, University Hospital Centre "Mother Teresa", Tirana, Albania.
authors.forename: Luan
authors.initials: L
authors.lastname: Xhelili
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Mehmedali
authors.initials: M
authors.lastname: Azemi
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Muharrem
authors.initials: M
authors.lastname: Avdiu
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Vlora
authors.initials: V
authors.lastname: Ismaili-Jaha
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Urata
authors.initials: U
authors.lastname: Efendija-Beqa
authors.affiliation: Pediatric Clinic, University Clinical Center of Kosova, Prishtina, Kosovo.
authors.forename: Violeta
authors.initials: V
authors.lastname: Grajcevci-Uka
keywords: Acute diarrhea; clinical dehydration scale; dehydration