Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA.
Acad Emerg Med. 2010 Oct;17(10):1035-41. doi: 10.1111/j.1553-2712.2010.00830.x.
The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale).
The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard.
Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale.
Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management.
本研究旨在确定两种不同的超声（US）方法评估儿童严重脱水的指标（腹主动脉与下腔静脉比和下腔静脉吸气塌陷）和一种临床严重脱水评估指标（世界卫生组织 [WHO] 脱水分级）的诊断性能。
作者招募了一个前瞻性队列，包括 3 家卢旺达农村医院就诊的腹泻和/或呕吐的儿童。使用 WHO 分级对儿童进行临床评估，然后由第二位临床医生进行 US 下腔静脉评估。所有儿童入院时均称重，然后根据标准医院方案进行液体复苏。入院和出院时体重变化百分比大于 10%被认为是严重脱水的标准。针对严重脱水的三个测试指标，分别与标准进行了接收者操作特征（ROC）曲线分析。
儿童年龄从 1 个月到 10 岁不等；根据标准，29%的儿童患有严重脱水。在测试的三种不同脱水评估方法中，只有 US 评估腹主动脉/下腔静脉比的 ROC 曲线下面积与参考线有统计学差异。在最佳截断点，腹主动脉/下腔静脉比的敏感性为 93%，特异性为 59%，而下腔静脉吸气塌陷的敏感性为 93%，特异性为 35%，WHO 分级的敏感性为 73%，特异性为 43%。
超声评估腹主动脉/下腔静脉比可用于识别急性腹泻的儿童中严重脱水，有助于指导临床管理。
