Diagnostic accuracy of three clinical dehydration scales: a systematic review

Area of Science:

• Pediatrics
• Emergency Medicine
• Diagnostic Accuracy Studies

Background:

• Dehydration is a common complication of acute gastroenteritis (AGE) in children.
• Accurate assessment of dehydration is crucial for timely and appropriate management.
• Several clinical scales exist to aid in this assessment, but their diagnostic accuracy varies.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of the Clinical Dehydration Scale (CDS), the WHO Scale, and the Gorelick Scale.
• To compare the effectiveness of these scales in identifying dehydration in children with AGE across different income settings.

Main Methods:

• A systematic review of diagnostic accuracy studies was conducted.
• Studies were identified through database searches, clinical trial registers, and reference lists.
• Sensitivity, specificity, positive likelihood ratio (LR), and negative LR were analyzed using percentage body weight loss as the reference standard.

Main Results:

• The CDS demonstrated moderate-to-large accuracy in predicting moderate to severe dehydration (≥6%) in high-income countries (positive LR 3.9-11.79), but limited value for ruling it out (negative LR 0.55-0.71).
• In low-income countries, the CDS had limited utility for assessing moderate to severe dehydration.
• The CDS showed poor accuracy for identifying no dehydration (<3%) or some dehydration (3%-6%) in any setting.
• The WHO Scale and Gorelick Scale showed limited or unconfirmed diagnostic accuracy for dehydration in children with AGE.

Conclusions:

• The Clinical Dehydration Scale (CDS) may aid in identifying moderate to severe dehydration in high-income settings, but its utility is limited elsewhere.
• The WHO Scale and Gorelick Scale are not recommended for assessing dehydration in children with AGE due to insufficient evidence of accuracy.