Sathyakiran Mudiganti, Chandramohan Anandhi, Palanisamy Soundararjan
Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillayarkuppam, Puducherry, India.
J Family Med Prim Care. 2024 Nov;13(11):4957-4960. doi: 10.4103/jfmpc.jfmpc_156_24. Epub 2024 Nov 18.
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.
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.
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.
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.
在印度，5岁以下儿童死亡的不可避免原因是急性腹泻疾病导致的脱水。尽管世界各地有各种脱水评估量表，但印度最常用的脱水评估量表是国际疾病分类及儿童健康问题综合管理（IMCI）量表。如果Gorelick 10分制量表在识别严重脱水方面的诊断准确性与IMCI量表相当，且具有更多临床指标，那么也可以考虑使用。我们的目的是根据体重、Gorelick 10分制量表、IMCI量表对1个月至60个月因腹泻疾病入院的儿童进行脱水评估分类，并比较Gorelick 10分制量表与IMCI量表在识别严重脱水方面的诊断准确性。
对224名1个月至60个月因急性水样腹泻入院的儿童进行前瞻性观察研究。使用体重、Gorelick 10分制量表、IMCI量表对儿童脱水严重程度进行评估。使用敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）、阴性似然比（LR-）、约登指数、准确性和kappa统计量等统计方法评估Gorelick 10分制量表与IMCI量表在识别严重脱水方面的诊断准确性，以检测评分者间的可靠性。
根据Gorelick 10分制量表、IMCI量表以及体重减轻百分比分类为无脱水、轻度脱水和重度脱水的参与者比例分别为79.9%、18.8%、1.3%；77.7%、21%、1.3%；79.9%、18.8%、1.3%。IMCI量表在识别严重脱水方面的诊断准确性高于Gorelick 10分制量表，其敏感性、特异性、PPV、NPV、LR+、LR-、约登指数和准确性分别为100%、97.2%、0%、100%、35.8、0、0.97、97.7%，而Gorelick 10分制量表相应指标分别为88.9%、97.2%、88.2%、97.2%、31.8、0.11、0.85、95.5%，kappa值为0.9。
尽管IMCI量表在识别严重脱水方面的诊断准确性略高于Gorelick 10分制量表，但kappa值为0.9表明两者具有极好的一致性，Gorelick 10分制量表可用于替代IMCI量表来识别严重脱水。
