Ultrasound assessment of severe dehydration in children with diarrhea and vomiting

Acad Emerg Med. 2010 Oct;17(10):1035-41. doi: 10.1111/j.1553-2712.2010.00830.x.


Objectives: The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale).

Methods: The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard.

Results: Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale.

Conclusions: Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management.

MeSH terms

  • Aorta / diagnostic imaging*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Confidence Intervals
  • Dehydration / etiology
  • Dehydration / physiopathology
  • Dehydration / therapy*
  • Developing Countries
  • Diarrhea / complications*
  • Diarrhea / diagnosis
  • Diarrhea / therapy
  • Female
  • Fluid Therapy / methods
  • Hemodynamics / physiology
  • Humans
  • Infant
  • Infusions, Intravenous
  • Male
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve
  • Risk Assessment
  • Rwanda
  • Severity of Illness Index
  • Treatment Outcome
  • Ultrasonography, Doppler
  • Vena Cava, Inferior / diagnostic imaging*
  • Vomiting / complications
  • Vomiting / diagnosis
  • Vomiting / therapy