Diagnostic accuracy of Gorelick 10 point scale in comparison to IMCI scale in identifying significant dehydration in
Mudiganti Sathyakiran1, Anandhi Chandramohan1, Soundararjan Palanisamy1
1Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillayarkuppam, Puducherry, India.
Insights
The Gorelick 10 point scale shows excellent agreement with the IMCI scale for assessing dehydration in young children with diarrhea. This suggests the Gorelick scale can be a reliable alternative for identifying significant dehydration in pediatric patients.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute diarrheal diseases cause significant mortality in children under 5 in India.
- Dehydration is a primary complication of these diseases.
- The Integrated Management of Childhood Illness (IMCI) scale is commonly used in India for dehydration assessment.
Purpose of the Study:
- To classify children aged 1-60 months with diarrhea based on dehydration severity.
- To compare the diagnostic accuracy of the Gorelick 10 point scale versus the IMCI scale.
- To evaluate the Gorelick scale's potential as an alternative to the IMCI scale.
Main Methods:
- A prospective observational study involving 224 children aged 1-60 months admitted with acute watery diarrhea.
- Assessment of dehydration severity using body weight, Gorelick 10 point scale, and IMCI scale.
- Statistical analysis of diagnostic accuracy, including sensitivity, specificity, PPV, NPV, and Kappa statistic.
Main Results:
- The proportion of children with no, some, and severe dehydration was similar across the Gorelick scale, IMCI scale, and weight loss percentage.
- The IMCI scale demonstrated slightly higher diagnostic accuracy for significant dehydration compared to the Gorelick scale.
- Excellent agreement (Kappa value of 0.9) was found between the two scales.
Conclusions:
- While IMCI showed marginally higher accuracy, the Gorelick 10 point scale exhibits excellent inter-rater reliability.
- The Gorelick 10 point scale can be effectively utilized as a substitute for the IMCI scale in identifying significant dehydration.
- This finding supports the potential for wider adoption of the Gorelick scale in clinical settings.
Background:
Unavoidable cause of mortality among under 5 children in India is dehydration resulting from acute diarrhoeal diseases. In spite of various dehydration scales available across the world, the most commonly used dehydration scale in India is IMCI. Gorelick 10 point scale having more clinical indicators could also be considered using if the diagnostic accuracy of the scale in identifying the significant dehydration is in par with that of IMCI scale. Our Objective was to classify the 1month - 60 month aged children admitted with diarrhoeal disease based on dehydration assessment using Body weight, Gorelick 10 point scale, IMCI scale and to compare the diagnostic accuracy of Gorelick 10 point scale vs IMCI scale in identifying significant dehydration.
Methods:
The prospective observational study was done among 224, 1 month to 60 month aged children admitted with acute watery diarrhea. The children were assessed for severity of dehydration using Body weight, Gorelick 10 point scale, IMCI scale. The diagnostic accuracy of Gorelick 10 point scale vs IMCI scale in identifying significant dehydration was assessed using statistical methods like, Sensitivity, Specificity, Positive Predictive Value PPV,NPV,LR+, LR-, Youden index and accuracy and Kappa statistic to detect inter-rater reliability.
Results:
The proportion of participants classified as to have no dehydration, some dehydration and severe dehydration according to Gorelick 10 point scale, IMCI and percentage of weight loss was 79.9%, 18.8%, 1.3% vs 77.7%,21%,1.3% vs 79.9%,18.8%,1.3% respectively The diagnostic accuracy of IMCI scale in identifying Significant dehydration was higher than Gorelick 10 point scale, as noted by having Sensitivity, Specificity,PPV,NPV,LR+,LR-,Youden index and accuracy as 100%,97.2%,0%,100%35.8,0,0.97,97.7% vs 88.9%,97.2%,88.2%,97.2%,31.8,0.11,0.85,95.5% respectively and k value was 0.9.
Conclusion:
Though the diagnostic accuracy of IMCI was little higher than Gorelick 10 point scale in identifying significant dehydration, having obtained k value of 0.9, indicates posing an excellent agreement Gorelick 10 point scale can be used in place of IMCI to identify Significant dehydration.
