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A prediction model for moderate or severe dehydration in children with diarrhoea
S P Zodpey1, S G Deshpande, S N Ughade
1Clinical Epidemiology Unit, Government Medical College, Nagpur, Maharashtra State, India.
Insights
This study developed a risk-scoring system to predict moderate or severe dehydration in young children with acute watery diarrhea. The validated system identifies key risk factors, enabling early intervention and potentially reducing mortality.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Acute watery diarrhea is a leading cause of dehydration in children under five.
- Predicting dehydration severity is crucial for timely and effective intervention.
- Existing methods for dehydration assessment may not be universally applicable or easily implemented.
Purpose of the Study:
- To devise and validate a risk-scoring system for predicting moderate or severe dehydration in children under five with acute watery diarrhea.
- To identify significant risk factors associated with dehydration development.
- To establish a reliable and accurate predictive tool for clinical use.
Main Methods:
- A hospital-based unmatched case-control study involving 387 cases and 387 controls.
- Unconditional multiple logistic regression analysis to identify significant risk factors.
- Receiver-operating characteristic (ROC) curve analysis to determine the optimal cut-off score.
Main Results:
- Twelve significant risk factors were identified, including infancy, undernutrition, and frequency of stools/vomiting.
- Statistical weights were assigned to each risk factor based on regression coefficients.
- A total score of 48 was identified as the optimal cut-off, with a predictive accuracy of 0.86 and sensitivity/specificity of 0.81.
Conclusions:
- The developed risk-scoring system demonstrates good predictive accuracy for moderate or severe dehydration in children.
- The system can aid in early identification of at-risk children, facilitating timely treatment.
- Further validation is recommended to support its widespread clinical application and reduce dehydration-related mortality.
Abstract:
A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools > 8/day, frequency of vomiting > 2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea--were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration.