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The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study
Joshua Jauregui1, Daniel Nelson2, Esther Choo2
1Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence 02912, RI, USA ; Division of Emergency Medicine, Harborview Medical Center, University of Washington, M/S 325 9th Avenue, Seattle 98104, WA, USA.
Insights
The ultrasound-measured inferior vena cava to aorta (IVC/Ao) ratio moderately predicts dehydration in children. However, inspiratory IVC collapse and physician gestalt were poor indicators of dehydration severity in this study.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Applications
Background:
- Previous studies suggest a correlation between the inferior vena cava to aorta (IVC/Ao) diameter ratio and dehydration levels in children.
- This study aimed to validate this correlation and assess the accuracy of ultrasound-measured inspiratory IVC collapse and physician gestalt in predicting significant dehydration in pediatric emergency departments.
Purpose of the Study:
- To externally validate the IVC/Ao ratio as a predictor of dehydration in children.
- To evaluate the accuracy of ultrasound-measured inspiratory IVC collapse and physician gestalt in predicting significant dehydration.
Main Methods:
- A prospective cohort of children (≤18 years) was enrolled.
- Ultrasound measurements (IVC diameter, Aorta diameter, IVC collapsibility) and physician gestalt were recorded.
- Dehydration was calculated by percent weight change; ≥5% indicated significant dehydration. ROC curves, sensitivity, and specificity were determined.
Main Results:
- The IVC/Ao ratio (cutoff 0.8) showed a modest predictive ability (AUC 0.72) with 67% sensitivity and 71% specificity.
- Inspiratory IVC collapse (cutoff 80%) had an AUC of 0.58, with 83% sensitivity and 42% specificity.
- Physician gestalt (cutoff 5) had an AUC of 0.61, with 42% sensitivity and 65% specificity.
Conclusions:
- The ultrasound-measured IVC/Ao ratio demonstrates moderate predictive value for significant dehydration in children.
- Inspiratory IVC collapse and physician gestalt were found to be poor predictors of dehydration severity in this cohort.
Background:
Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department.
Methods:
We prospectively enrolled a non-consecutive cohort of children ≤18 years old. Patient weight, ultrasound measurements of the IVC and Ao, and physician gestalt were recorded. The percent weight change from presentation to discharge was used to calculate the degree of dehydration. A weight change of ≥5% was considered clinically significant dehydration. Receiver operating characteristic (ROC) curves were constructed for each of the ultrasound measurements and physician gestalt. Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater. Intra-class correlation coefficients were calculated to assess the degree of inter-rater reliability between ultrasound observers.
Results:
Of 113 patients, 10.6% had significant dehydration. The IVC/Ao ratio had an area under the ROC curve (AUC) of 0.72 (95% CI 0.53 to 0.91) and, with a cutoff of 0.8, produced a SN of 67% and a SP of 71% for the diagnosis of significant dehydration. The IVC collapsibility index of 50% had an AUC of 0.58 (95% CI 0.44 to 0.72) and, with a cutoff of 80% collapsibility, produced a SN of 83% and a SP of 42%. The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility. Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.
Conclusions:
The ultrasound-measured IVC/Ao ratio is a modest predictor of significant dehydration in children. The inspiratory IVC collapse and physician gestalt were poor predictors of the actual level of dehydration in this study.
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