Gorelick M H, Shaw K N, Murphy K O
Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104-6021, USA.
Pediatrics. 1997 May;99(5):E6. doi: 10.1542/peds.99.5.e6.
To determine the validity and reliability of various clinical findings in the diagnosis of dehydration in children.
Prospective cohort study.
An urban pediatric hospital emergency department.
One hundred eighty-six children ranging in age from 1 month to 5 years old with diarrhea, vomiting, or poor oral fluid intake, either admitted or followed as outpatients. Exclusion criteria included malnutrition, recent prior therapy at another facility, symptoms for longer than 5 days' duration, and hyponatremia or hypernatremia.
All children were evaluated for 10 clinical signs before treatment. The diagnostic standard for dehydration was fluid deficit as determined from serial weight gain after treatment.
Sixty-three children (34%) had dehydration, defined as a deficit of 5% or more of body weight. At this deficit, clinical signs were already apparent (median = 5). Individual findings had generally low sensitivity and high specificity, although parent report of decreased urine output was sensitive but not specific. The presence of any three or more signs had a sensitivity of 87% and specificity of 82% for detecting a deficit of 5% or more. A subset of four factors-capillary refill >2 seconds, absent tears, dry mucous membranes, and ill general appearance-predicted dehydration as well as the entire set, with the presence of any two or more of these signs indicating a deficit of at least 5%. Interobserver reliability was good to excellent for all but one of the findings studied (quality of respirations).
Conventionally used clinical signs of dehydration are valid and reliable; however, individual findings lack sensitivity. Diagnosis of clinically important dehydration should be based on the presence of at least three clinical findings.
确定各种临床检查结果在儿童脱水诊断中的有效性和可靠性。
前瞻性队列研究。
一家城市儿科医院急诊科。
186名年龄在1个月至5岁之间、患有腹泻、呕吐或口服液体摄入不足的儿童，这些儿童要么住院，要么作为门诊患者接受随访。排除标准包括营养不良、近期在其他机构接受过治疗、症状持续时间超过5天以及低钠血症或高钠血症。
所有儿童在治疗前均接受10项临床体征评估。脱水的诊断标准是根据治疗后连续体重增加确定的液体缺失量。
63名儿童（34%）存在脱水，定义为体重缺失5%或更多。在这种缺失情况下，临床体征已经很明显（中位数 = 5）。尽管家长报告尿量减少具有敏感性但不具有特异性，但个别检查结果的敏感性一般较低，特异性较高。出现任何三项或更多体征时，检测体重缺失5%或更多的敏感性为87%，特异性为82%。四个因素的子集——毛细血管再充盈时间>2秒、无泪、口腔黏膜干燥和一般外观不佳——对脱水的预测效果与全部体征相同，出现这些体征中的任何两项或更多项表明体重至少缺失5%。除一项研究结果（呼吸质量）外，所有其他研究结果的观察者间可靠性均良好至优秀。
传统上使用的脱水临床体征是有效且可靠的；然而，个别检查结果缺乏敏感性。具有临床意义的脱水诊断应基于至少三项临床检查结果的存在。
