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External validation of the clinical dehydration scale for children with acute gastroenteritis
Benoit Bailey1, Jocelyn Gravel, Ran D Goldman
1Division of Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada. benoit.bailey@umontreal.ca
Insights
The Clinical Dehydration Scale (CDS) effectively predicts longer emergency department (ED) stays for children with gastroenteritis. This validation confirms its utility in diverse pediatric settings for assessing dehydration severity and its impact on patient length of stay (LOS).
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment Tools
- Gastroenteritis Management
Background:
- Accurate assessment of dehydration is crucial for managing pediatric gastroenteritis.
- The Clinical Dehydration Scale (CDS) was previously developed to quantify dehydration severity.
- Validation in new clinical environments is essential for broader applicability.
Purpose of the Study:
- To validate the Clinical Dehydration Scale (CDS) in a pediatric emergency department (ED) distinct from its origin.
- To assess the correlation between CDS scores and length of stay (LOS) in pediatric patients with gastroenteritis.
Main Methods:
- A prospective cohort study enrolled 150 children (1 month to 5 years) with gastroenteritis.
- Triage nurses applied the CDS, scoring dehydration severity (0-8) based on clinical characteristics.
- Length of stay (LOS) from physician assessment to discharge was the primary outcome, analyzed using the Kruskal-Wallis test.
Main Results:
- Patients were categorized into no dehydration (n=56), some dehydration (n=74), and moderate/severe dehydration (n=20).
- Median LOS significantly increased with dehydration severity: 54 minutes (no dehydration), 128 minutes (some dehydration), and 425 minutes (moderate/severe dehydration) (p < 0.001).
- The CDS demonstrated a strong correlation between dehydration severity and ED length of stay.
Conclusions:
- The Clinical Dehydration Scale (CDS) is validated in a new pediatric emergency department setting.
- The CDS is a reliable predictor of emergency department length of stay for children with gastroenteritis.
- This tool aids in predicting resource utilization based on dehydration severity.
Objectives:
The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated.
Methods:
A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test.
Results:
From April 2008 to March 2009, 150 patients with a mean (+/-SD) age of 22 (+/-14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26-175 minutes), 128 minutes (IQR = 25-334 minutes), and 425 minutes (IQR = 218-673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001).
Conclusions:
The CDS has been further validated in children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician.
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