Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):278-288. 10.5223/pghn.2018.21.4.278.

Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time

• Caruggi S
• Rossi M
• De Giacomo C
• Luini C
• Ruggiero N
• Salvatoni
• Salvatore

• KMID: 2421990
• DOI: http://doi.org/10.5223/pghn.2018.21.4.278

Abstract

PURPOSE
Dehydration is a paediatric medical emergency but there is no single standard parameter to evaluate it at the emergency department. Our aim was to evaluate the reliability and validity of capillary refilling time as a triage parameter to assess dehydration in children.
METHODS
This was a prospective pilot cohort study of children who presented to two paediatric emergency departments in Italy, with symptoms of dehydration. Reliability was assessed by comparing the triage nurse's measurements with those obtained by the physician. Validity was demonstrated by using 6 parameters suggestive of dehydration. Comparison between refilling time (RT) and a validated Clinical Dehydration Score (CDS) was also considered. The scale's discriminative ability was evaluated for the outcome of starting intravenous rehydration therapy by using a receiver operating characteristic (ROC) curve.
RESULTS
Participants were 242 children. All nurses found easy to elicit the RT after being trained. Interobserver reliability was fair, with a Cohen's kappa of 0.56 (95% confidence interval [CI], 0.41 to 0.70). There was a significant correlation between RT and weight loss percentage (r-squared=−0.27; 95% CI, −0.47 to −0.04). The scale's discriminative ability yielded an area under the ROC curve (AUC) of 0.65 (95% CI, 0.57 to 0.73). We found a similarity between RT AUC and CDS-scale AUC matching the two ROC curves.
CONCLUSION
The study showed that RT represents a fast and handy tool to recognize dehydrated children who need a prompt rehydration and may be introduced in the triage line-up.

Keyword

Dehydration; Triage; Child; Gastroenteritis; Diarrhea; Vomiting

MeSH Terms

Area Under Curve
Capillaries
Child
Cohort Studies
Dehydration*
Diarrhea
Emergencies
Emergency Service, Hospital
Fluid Therapy
Gastroenteritis
Humans
Italy
Prospective Studies*
Reproducibility of Results
ROC Curve
Triage*
Vomiting
Weight Loss

Figure

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  Fig. 1 How to assess capillary refilling time at the triage.

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  Fig. 2 Data collection form.

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  Fig. 3 New data collection form.

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  Fig. 4 Receiver operating characteristic curve results of refilling time (A) and Clinical Dehydration Score (B).

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