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Prediction of severe disease in children with diarrhea in a resource-limited setting

Adam C Levine1, Richard M Munyaneza2, Justin Glavis-Bloom1

  • 1Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America.

Plos One
|December 19, 2013
PubMed

Insights

The Clinical Dehydration Scale showed the best accuracy in predicting severe disease in children with diarrhea in resource-limited settings. Accuracy varied by provider training and child age, highlighting the need for improved assessment tools.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Global Health

Background:

  • Diarrhea is a leading cause of childhood mortality globally, particularly in resource-limited settings.
  • Accurate assessment of disease severity is crucial for timely and appropriate management of childhood diarrhea.
  • Existing clinical scales for predicting severe outcomes in children with diarrhea require validation in diverse settings.

Purpose of the Study:

  • To evaluate the predictive accuracy of three clinical scales for severe disease (severe dehydration or death) in children with diarrhea.
  • To compare the performance of the World Health Organization (WHO) severe dehydration scale, the Centers for Disease Control (CDC) scale, and a post-hoc Clinical Dehydration Scale.
  • To assess the influence of provider training and patient age on scale accuracy in a resource-limited context.

Main Methods:

  • A prospective study involving 178 children admitted with diarrhea to three Rwandan hospitals.
  • Clinical assessment using the WHO severe dehydration scale and CDC scale by local physicians or nurses.
  • Definition of severe dehydration based on a 10% increase in weight from admission to stable weight; construction of the Clinical Dehydration Scale post-hoc.
  • Receiver Operator Characteristic (ROC) curve analysis to determine the Area Under the Curve (AUC) for each scale.

Main Results:

  • The Clinical Dehydration Scale demonstrated the highest AUC (0.80) in the full cohort, outperforming the WHO (0.72) and CDC (0.73) scales.
  • The Clinical Dehydration Scale was a significant predictor in infants (AUC 0.77) and when used by nurses (AUC 0.78).
  • All three scales showed moderate predictive accuracy, but performance varied.

Conclusions:

  • All evaluated clinical scales offer moderate accuracy in predicting severe outcomes in children with diarrhea.
  • Provider training and patient age significantly impact the accuracy of these scales.
  • There is a critical need for developing and validating accurate, user-friendly clinical tools for assessing children with diarrhea, especially for nurses and less-skilled providers in resource-limited settings.
Abstract

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