Correlation between clinical and ultrasonographic assessment of dehydration in children

Abstract

Background: Dehydration often secondary to acute gastroenteritis is a common pediatric condition causing significant morbidity and mortality in the developing world. Since clinical assessment has interobserver variation because of symptomatic nature of signs and symptoms, objective assessment of intravascular volume status by measuring IVC diameter and IVC/Aorta diameter ratio helps to identify the severity of dehydration and thus influence treatment decisions.

Objectives: 1. To assess the severity of dehydration in children aged 6 months-16 years by bedside ultrasound measurement of IVC diameter and IVC/Ao ratio.

1. Compare it with the clinical assessment of dehydration.

STUDY DESIGN: This was a hospital-based cross-sectional study from June 2017 to May 2019.

METHODS AND METHODS: The present study consisted of 60 pairs of cases and controls. Cases were categorized into different degrees of dehydration viz NO/MILD, SOME and SEVERE dehydration by clinical assessment. All the controls were euvolemic. IVC diameter and IVC/Ao ratio were measured both pre and post hydration by bedside USG. Similarly IVC diameter and IVC/Ao ratio was seen in euvolemic controls. The comparison was done between IVC diameter and IVC/Ao ratio between cases (pre-hydration) on one side and cases (post-hydration) along with controls on other side.

RESULTS: A total of 60 pairs of cases and controls were studied. Mean IVC/Ao ratio of cases (prehydration) , cases (posthydration) and controls was 0.799±0.122, 0.957±0.039 and 0.9553±0.42 cms respectively. A significant difference was seen in IVC diameters and IVC/Ao ratio between pre and post hydration measurement in cases (p <0.001) . Similarly IVC diameters and IVC/AOoratio between cases (prehydration) on one side and cases (posthydration) along with controls on other side. A significant difference was seen in these parameters (p <0.001) .

CONCLUSION: Bedside USG is rapid, noninvasive and painless modality. Measuring IVC/Ao ratio by USG offers an objective method for assessment of pediatric dehydration. Clinical assessment has interobserver variation because of subjective nature of signs and symptoms. We found that the IVC/Ao ratio is lower in those who were clinically found to be dehydrated than euvolemic controls and also different ratio was found in different degrees of dehydration. Also IVC/Ao ratio increased after IV hydration.