Accuracy of inferior vena cava ultrasound for predicting dehydration in children with acute diarrhea in resource-limited settings

• Type of Material: Article
• Authors: Payal Modi, Brown University; Justin Glavis-Bloom, Brown University; Sabiha Nasrin, International Centre for Diarrhoeal Disease Research; Allysia Guy, Lincoln Medical and Mental Health Center; Erika Chowa, Emory University; Nathan Dvor, Lincoln Medical and Mental Health Center; Daniel A. Dworkis, Harvard Medical School; Michael Oh, Lincoln Medical and Mental Health Center; David M. Silvestri, Harvard Medical School; Stephen Strasberg, Lincoln Medical and Mental Health Center; Soham Rege, Brown University; Vicki E. Noble, Harvard Medical School; Nur H. Alam, International Centre for Diarrhoeal Disease Research; Adam C. Levine, Brown University
• Language: English
• Date: 2016-01-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Modi et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0146859
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 11
• Issue: 1
• Start Page: e0146859
• End Page: e0146859
• Grant/Funding Information: This research was funded by the US National Institutes of Health Fogarty International Center (grant number 1K01TW009208-01A1) and the University Emergency Medicine Foundation (http://www.uemf.org).
• Keywords: Dehydration; Vena Cava, Inferior; Point-of-Care Systems; ROC Curve; Male; Humans; Prospective Studies; Female; Infant; Ultrasonography; Acute Disease; Aorta; Reproducibility of Results; Risk Factors; Child, Preschool; Diarrhea; Prognosis

Abstract

Introduction: 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.