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. 2016 Jan 14;11(1):e0146859.
doi: 10.1371/journal.pone.0146859. eCollection 2016.

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings

Payal Modi  1 , Justin Glavis-Bloom  1 , Sabiha Nasrin  2 , Allysia Guy  3 , Erika P Chowa  4 , Nathan Dvor  3 , Daniel A Dworkis  4 , Michael Oh  3 , David M Silvestri  4 , Stephen Strasberg  3 , Soham Rege  1 , Vicki E Noble  4 , Nur H Alam  2 , Adam C Levine  1
Affiliations

Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings

Payal Modi et al. PLoS One. .

Abstract

Introduction: 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.

Objective: To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children.

Methods: 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.

Results: 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.

Conclusions: 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.

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Conflict of interest statement

Competing Interests: The authors have declared no competing interests exist.

Figures

Fig 1
Fig 1. Patient enrollment.
Fig 2
Fig 2. ROC curves of Aorta-to-IVC ratio for predicting dehydration.
Fig 3
Fig 3. Change in IVC and Aorta diameter with Rehydration.
See this image and copyright information in PMC

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