Modi Payal, Glavis-Bloom Justin, Nasrin Sabiha, Guy Allysia, Chowa Erika P, Dvor Nathan, Dworkis Daniel A, Oh Michael, Silvestri David M, Strasberg Stephen, Rege Soham, Noble Vicki E, Alam Nur H, Levine Adam C
Department of Emergency Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America.
International Centre for Diarrhoeal Disease Research, Mohakhali, Dhaka, Bangladesh.
PLoS One. 2016 Jan 14;11(1):e0146859. doi: 10.1371/journal.pone.0146859. eCollection 2016.
Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy.
To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.
A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having "some dehydration" with weight change 3-9% or "severe dehydration" with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity.
850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor.
Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting.
尽管腹泻导致的脱水是五岁以下儿童发病和死亡的主要原因，但现有的评估儿童脱水状况的方法准确性有限。
评估床旁超声测量主动脉与下腔静脉比值作为儿童脱水预测指标的准确性。
在孟加拉国腹泻病研究国际中心（icddr，b）的补液单元对五岁以下急性腹泻儿童进行了一项前瞻性队列研究。在患者入院时获得主动脉与下腔静脉比值的超声测量值和脱水体重。在补液过程中监测体重变化百分比，将体重变化3 - 9%的儿童分类为“轻度脱水”，体重变化> 9%的儿童分类为“重度脱水”。采用逻辑回归分析和受试者工作特征（ROC）曲线评估主动脉与下腔静脉比值作为脱水严重程度预测指标的准确性。
共纳入850名儿童，其中771名纳入最终分析。主动脉与下腔静脉比值是急性腹泻儿童脱水百分比的显著预测指标，主动脉与下腔静脉比值每增加1个单位，儿童脱水百分比增加1.1%。然而，预测重度脱水的ROC曲线下面积（0.60）、敏感性（67%）和特异性（49%）均较差。
床旁超声测量主动脉与下腔静脉比值与容量状态在统计学上相关，但在资源有限的环境中，对于五岁以下急性腹泻儿童，其准确性不足以作为脱水的独立筛查工具。
