Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 545-549 (doi:10.1542/peds.2007-3141)
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ARTICLE

Validation of the Clinical Dehydration Scale for Children With Acute Gastroenteritis

Ran D. Goldman, MDa,b, Jeremy N. Friedman, MB, ChB, FRCPCc,d and Patricia C. Parkin, MD, FRCPCc,d

a Pediatric Research in Emergency Therapeutics Program, Division of Pediatric Emergency Medicine, BC Children's Hospital, Vancouver, Canada
b Department of Pediatrics, Child and Family Research Institute, University of British Columbia, Vancouver, Canada
c Pediatric Outcomes Research Team, Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Canada
d Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada

OBJECTIVE. We previously created a clinical dehydration scale. Our objective was to validate the clinical dehydration scale with a new cohort of patients with acute gastroenteritis who were assessed in a tertiary emergency department in a developed country.

METHODS. A prospective observational study was performed in an emergency department at a large pediatric tertiary center in Canada. Children 1 month to 5 years of age with symptoms of acute gastroenteritis who were assessed in the emergency department were enrolled consecutively during a 4-month period. The main outcome measures were length of stay, proportion of children receiving intravenous fluid rehydration, and proportions of children with abnormal serum pH values or bicarbonate levels.

RESULTS. A total of 205 children were enrolled, with a mean age of 22.4 ± 14.9 months; 103 (50%) were male. The distribution of severity categories was as follows: no dehydration (score of 0), n = 117 (57%); some dehydration (score of 1–4), n = 83 (41%); moderate/severe dehydration (score of 5–8), n = 5 (2%). The 3 dehydration categories were significantly different with respect to the validation hypotheses (length of stay, mean ± SD: none, 245 ± 181 minutes; some, 397 ± 302 minutes; moderate/severe, 501 ± 389 minutes; treatment with intravenous fluids: none, n =17, 15%; some, n = 41, 49%; moderate/severe, n = 4, 80%; number of vomiting episodes in the 7 days before the emergency department visit: none, 8.4 ± 7.7 episodes; some, 13 ± 10.7 episodes; moderate/severe, 30.2 ± 14.8 episodes).

CONCLUSION. The clinical dehydration scale and the 3 severity categories were valid for a prospectively enrolled cohort of patients who were assessed in our tertiary emergency department. The scoring system was valuable in predicting a longer length of stay and the need for intravenous fluid rehydration for children with symptoms of acute gastroenteritis.

Key Words: scale • validation • dehydration • gastroenteritis

Abbreviations: CDS—clinical dehydration scale • ED—emergency department • AGE—acute gastroenteritis • LOS—length of stay

Accepted Dec 18, 2007.


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