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Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
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Inferior vena cava to aorta ratio in dehydrated pediatric patients: a systematic review and meta-analysis
Gilbert Sterling Octavius1, Michelle Imanuelly1, Johan Wibowo1
1Department of Pediatrics, Universitas Pelita Harapan, Jakarta, Indonesia.
Insights
The inferior vena cava to aorta (IVC/Ao) ratio shows promise for assessing pediatric dehydration but is currently insufficient for definitive diagnosis. Further multicenter research is needed to establish its clinical utility in identifying dehydration severity.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Critical Care
Background:
- Dehydration from acute diarrhea is a leading cause of mortality in children.
- Current methods struggle to accurately differentiate dehydration severity.
- Ultrasound's IVC/Ao ratio offers a potential noninvasive tool for assessing pediatric dehydration.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of the IVC/Ao ratio for predicting significant dehydration in pediatric patients.
- To evaluate the IVC/Ao ratio's performance in identifying dehydration in children presenting with acute diarrhea, gastroenteritis, or vomiting.
Main Methods:
- Searched MEDLINE, PubMed, Cochrane Library, ScienceDirect, and Google Scholar for relevant studies.
- Included studies on pediatric patients (≤18 years) with dehydration symptoms.
- Conducted a meta-analysis using Stata software (midas and metandi commands).
Main Results:
- Five studies with 461 patients were analyzed.
- Combined sensitivity was 86% (95% CI, 79%-91%) and specificity was 73% (95% CI, 59%-84%).
- Area under the curve (AUC) was 0.89 (95% CI, 0.86-0.91), indicating good diagnostic performance.
Conclusions:
- The IVC/Ao ratio alone is insufficient to definitively exclude or confirm significant dehydration in pediatric patients.
- More robust, multicenter, and adequately powered diagnostic research is required.
- Further studies are needed to establish the definitive clinical usefulness of the IVC/Ao ratio.
Background:
Dehydration due to acute diarrhea is among the leading causes of mortality. However, advancements in management and technology do not help clinicians differentiate dehydration degrees. Ultrasound using the inferior vena cava to aorta (IVC/ Ao) ratio is a promising noninvasive technique to identify significant pediatric dehydration.
Puspose:
Therefore, this systematic review and meta-analysis aimed to examine the diagnostic parameters of the IVC/Ao ratio for predicting clinically significant dehydration in pediatric patients.
Methods:
We searched the MEDLINE, PubMed, Cochrane Library, ScienceDirect, and Google Scholar databases for studies of pediatric patients (≤18 years old) who presented with signs and symptoms of dehydration due to acute diarrhea, gastroenteritis, or vomiting. The inclusion criteria were cross-sectional, case-control, cohort, and randomized controlled trial study design and publication in any language. We then conducted a meta-analysis using the midas and metandi commands from Stata software.
Results:
Five studies of 461 patients were included. The combined sensitivity was 86% (95% confidence interval [CI], 79%-91%), while the specificity was 73% (95% CI, 59%-84%). The area under the curve was 0.89 (95% CI, 0.86-0.91). The positive likelihood ratio (LR+) was 3.2 (95% CI, 2.1-5.1) with a 76% posttest probability, while the negative likelihood ratio (LR-) was 0.18 (95% CI, 0.12-0.28) with a 16% posttest probability. The combined negative predictive value was 0.83 (95% CI, 0.75-0.91), while the positive predictive value was 0.75 (95% CI, 0.68-0.82).
Conclusion:
The IVC/Ao ratio was insufficient to exclude or confirm significant dehydration in pediatric patients. More studies are needed, especially multicenter, adequately powered diagnostic research, to will help establish the usefulness of the IVC/Ao ratio.
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