Levine Adam C, Barry Meagan A, Gainey Monique, Nasrin Sabiha, Qu Kexin, Schmid Christopher H, Nelson Eric J, Garbern Stephanie C, Monjory Mahmuda, Rosen Rochelle, Alam Nur H
Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America.
Rhode Island Hospital, Providence, Rhode Island, United States of America.
PLoS Negl Trop Dis. 2021 Mar 10;15(3):e0009266. doi: 10.1371/journal.pntd.0009266. eCollection 2021 Mar.
Diarrheal diseases lead to an estimated 1.3 million deaths each year, with the majority of those deaths occurring in patients over five years of age. As the severity of diarrheal disease can vary widely, accurately assessing dehydration status remains the most critical step in acute diarrhea management. The objective of this study is to empirically derive clinical diagnostic models for assessing dehydration severity in patients over five years with acute diarrhea in low resource settings. We enrolled a random sample of patients over five years with acute diarrhea presenting to the icddr,b Dhaka Hospital. Two blinded nurses independently assessed patients for symptoms/signs of dehydration on arrival. Afterward, consecutive weights were obtained to determine the percent weight change with rehydration, our criterion standard for dehydration severity. Full and simplified ordinal logistic regression models were derived to predict the outcome of none (<3%), some (3-9%), or severe (>9%) dehydration. The reliability and accuracy of each model were assessed. Bootstrapping was used to correct for over-optimism and compare each model's performance to the current World Health Organization (WHO) algorithm. 2,172 patients were enrolled, of which 2,139 (98.5%) had complete data for analysis. The Inter-Class Correlation Coefficient (reliability) was 0.90 (95% CI = 0.87, 0.91) for the full model and 0.82 (95% CI = 0.77, 0.86) for the simplified model. The area under the Receiver-Operator Characteristic curve (accuracy) for severe dehydration was 0.79 (95% CI: 0.76-0.82) for the full model and 0.73 (95% CI: 0.70, 0.76) for the simplified model. The accuracy for both the full and simplified models were significantly better than the WHO algorithm (p<0.001). This is the first study to empirically derive clinical diagnostic models for dehydration severity in patients over five years. Once prospectively validated, the models may improve management of patients with acute diarrhea in low resource settings.
腹泻病每年估计导致130万人死亡，其中大多数死亡发生在五岁以上的患者中。由于腹泻病的严重程度差异很大，准确评估脱水状态仍然是急性腹泻管理中最关键的一步。本研究的目的是通过实证得出用于评估资源匮乏地区五岁以上急性腹泻患者脱水严重程度的临床诊断模型。我们纳入了达卡医院icddr，b就诊的五岁以上急性腹泻患者的随机样本。两名盲法护士在患者入院时独立评估脱水症状/体征。之后，连续测量体重以确定补液后体重变化百分比，这是我们评估脱水严重程度的标准。推导了完整和简化的有序逻辑回归模型，以预测无脱水（<3%）、轻度脱水（3-9%）或重度脱水（>9%）的结果。评估了每个模型的可靠性和准确性。采用自助法校正过度乐观偏差，并将每个模型的性能与当前世界卫生组织（WHO）算法进行比较。共纳入2172例患者，其中2139例（98.5%）有完整数据用于分析。完整模型的组内相关系数（可靠性）为0.90（95%CI=0.87，0.91），简化模型为0.82（95%CI=0.77，0.86）。重度脱水的受试者工作特征曲线下面积（准确性），完整模型为0.79（95%CI：0.76-0.82），简化模型为0.73（95%CI：0.70，0.76）。完整模型和简化模型的准确性均显著优于WHO算法（p<0.001）。这是第一项通过实证得出五岁以上患者脱水严重程度临床诊断模型的研究。一旦经过前瞻性验证，这些模型可能会改善资源匮乏地区急性腹泻患者的管理。
