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Use of Bedside Ultrasound to Assess Degree of Dehydration in Children With Gastroenteritis

  1. Lei Chen MD,
  2. Allen Hsiao MD,
  3. Melissa Langhan MD,
  4. Antonio Riera MD,
  5. Karen A. Santucci MD

Article first published online: 12 OCT 2010

DOI: 10.1111/j.1553-2712.2010.00873.x

Issue

Academic Emergency Medicine

Academic Emergency Medicine

Volume 17, Issue 10, pages 1042–1047, October 2010

Additional Information

How to Cite

Chen, L., Hsiao, A., Langhan, M., Riera, A. and Santucci, K. A. (2010), Use of Bedside Ultrasound to Assess Degree of Dehydration in Children With Gastroenteritis. Academic Emergency Medicine, 17: 1042–1047. doi: 10.1111/j.1553-2712.2010.00873.x

Author Information

  1. From the Section of Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.

*Address for correspondence and reprints: Lei Chen, MD; e-mail: lei.chen@yale.edu.

  1. Presented at the Pediatric Academic Society annual meeting, Baltimore, MD, May 2009.

  2. Supported in part by CTSA, grant KL2 RR024138 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research.

  3. Supervising Editor: Bema Bonsu, MD.

Publication History

  1. Issue published online: 12 OCT 2010
  2. Article first published online: 12 OCT 2010
  3. Received December 15, 2009; revisions received March 16 and April 19, 2010; accepted April 20, 2010.

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Keywords:

  • gastroenteritis;
  • ultrasound;
  • pediatrics

Abstract

Objectives:  Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by our group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis. Another objective was to investigate the interrater reliability of the IVC/Ao measurements.

Methods:  A prospective observational study was carried out in a pediatric emergency department (PED) between November 2007 and June 2009. Children with acute gastroenteritis were enrolled as subjects. A pair of investigators obtained transverse images of the IVC and Ao using bedside US. The ratio of IVC and Ao diameters (IVC/Ao) was calculated. Subjects were asked to return after resolution of symptoms. The difference between the convalescent weight and ill weight was used to calculate the degree of dehydration. Greater than or equal to 5% difference was judged to be significant. Linear regression was performed with dehydration as the dependent variable and the IVC/Ao as the independent variable. Pearson’s correlation coefficient was calculated to assess the degree of agreement between observers.

Results:  A total of 112 subjects were enrolled. Seventy-one subjects (63%) completed follow-up. Twenty-eight subjects (39%) had significant dehydration. The linear regression model resulted in an R2 value of 0.21 (p < 0.001) and a slope (B) of 0.11 (95% confidence interval [CI] = 0.08 to 0.14). An IVC/Ao cutoff of 0.8 produced a sensitivity of 86% and a specificity of 56% for the diagnosis of significant dehydration. Forty-eight paired measurements of IVC/Ao ratios were made. The Pearson correlation coefficient was 0.76.

Conclusions:  In this pilot study the ratio of IVC to Ao diameters, as measured by bedside US, was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis. The technique demonstrated good interrater reliability.

ACADEMIC EMERGENCY MEDICINE 2010; 17:1042–1047 © 2010 by the Society for Academic Emergency Medicine

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