title: Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings.
abstract: BACKGROUND
  Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.
  
  
  OBJECTIVE
  To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.
  
  
  METHODS
  A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.
  
  
  RESULTS
  850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor.
  
  
  CONCLUSIONS
  Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.
authors.affiliation: Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Payal
authors.initials: P
authors.lastname: Modi
authors.affiliation: Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Justin
authors.initials: J
authors.lastname: Glavis-Bloom
authors.affiliation: International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
authors.forename: Sabiha
authors.initials: S
authors.lastname: Nasrin
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America.
authors.forename: Allysia
authors.initials: A
authors.lastname: Guy
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Erika P
authors.initials: EP
authors.lastname: Chowa
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America.
authors.forename: Nathan
authors.initials: N
authors.lastname: Dvor
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Dworkis
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Silvestri
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Strasberg
authors.affiliation: Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Soham
authors.initials: S
authors.lastname: Rege
authors.affiliation: Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.affiliation: International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
authors.forename: Nur H
authors.initials: NH
authors.lastname: Alam
authors.affiliation: Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Levine
mesh_terms: D000208:Acute Disease; D001011:Aorta / Q000000981:diagnostic imaging; D002675:Child, Preschool; D003681:Dehydration / Q000000981:diagnostic imaging* / Q000209:etiology*; D003967:Diarrhea / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*