Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

Mazza, Genevieve; Romo, Carina Mireles; Torres, Marlene; Duffens, Ali; Vyas, Annasha; Moran, Katherine; Livingston, Joshua K; Gonzales, Savannah; Lahham, Shadi; Shniter, Inna; Thompson, Maxwell; Fox, J. Christian

doi:10.5847/wjem.j.1920-8642.2019.01.007

Cited by 6 publications

(6 citation statements)

References 11 publications

(12 reference statements)

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“…[18][19][20] However, these results have been refuted in further studies. 21,22 Urine testing has also been considered as a marker of dehydration, although a prospective cohort study found urinary specific gravity and urine ketones did not correlate with degree of pediatric dehydration. 23 A meta-analysis of noninvasive methods for diagnosis of pediatric dehydration also found that available did not support ultrasound or urinalysis for routine assessment of pediatric dehydration.…”

Section: Discussionmentioning

confidence: 99%

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Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment

et al. 2022

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Objective: Dehydration is a commonly encountered problem worldwide.Current clinical assessment is limited by subjectivity and limited provider training with children. The objective of this study is to investigate a new noninvasive, point-of-care technology that measures capillary refill combined with patient factors to accurately diagnose dehydration.Methods: This is a prospective observational study at a tertiary care children's hospital in Buenos Aires, Argentina. Patients were eligible if younger than 10 years who presented to the emergency department with vomiting and/or diarrhea whom the triage nurse deems to be potentially dehydrated. Patients had the digital capillary refill device done on presentation in addition to standard of care vital signs and weight. Patients had serial weights measured on hospital scales throughout their stay. The primary outcome was dehydration, which was calculated as a percent change in weight from admission to discharge.Results: Seventy-six children were enrolled in the study with 56 included in the final analysis. A stepwise forward method selection chose malnutrition, temperature, and systolic blood pressure for the multivariable model. The area under the curve for the final model was fair (0.7431). To further look into the utility of such a device in the home setting where blood pressure is not available often, we reran the model without systolic blood pressure. The area under the curve for the final model was 0.7269. Conclusions:The digital capillary refill point-of-care device combined with readily available patient-specific factors may improve the ability to detect pediatric dehydration and facilitate earlier treatment or transfer to higher levels of care.

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Section: Discussionmentioning

confidence: 99%

“…Several initial studies showed promising results 18–20 . However, these results have been refuted in further studies 21,22 . Urine testing has also been considered as a marker of dehydration, although a prospective cohort study found urinary specific gravity and urine ketones did not correlate with degree of pediatric dehydration 23 .…”

Section: Discussionmentioning

confidence: 99%

Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment

et al. 2022

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“…Our results differ from those of previous studies in North American children showing that an IVC/Ao ratio ≤ 0.8 modestly predicts severe dehydration after acute diarrhoea [ 24 , 35 ]. However, using the same cutoff value among rural children in Panama, Mazza et al found no difference in IVC/Ao ratio between children with and without severe dehydration [ 49 ]. Two additional paediatric studies, one conducted in Rwanda [ 50 ], the other in Bangladesh [ 51 ], found a significant correlation between the aorta-to-IVC ratio and dehydration in children with acute diarrhoea; the larger study from Bangladesh concluded, however, that a cutoff value ≥ 2.0 was not sufficiently accurate to recommend as a stand-alone screening tool for dehydration in children [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…Median (IQR) IVC-CI on enrolment was increased in malaria patients (42% [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]) relative to healthy participants (35% [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]; p = 0.01), but was similar between patients with severe (38% ) and uncomplicated malaria (44% [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]; p = 0.055). The share of p...…”

Section: Markers Of Clinical Severitymentioning

confidence: 99%

Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients

et al. 2021

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Purpose Fluid management is challenging in malaria patients given the risks associated with intravascular fluid depletion and iatrogenic fluid overload leading to pulmonary oedema. Given the limitations of the physical examination in guiding fluid therapy, we evaluated point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) and lungs as a novel tool to assess volume status and detect early oedema in malaria patients. Methods To assess the correlation between IVC and lung ultrasound (LUS) indices and clinical signs of hypovolaemia and pulmonary oedema, respectively, concurrent clinical and sonographic examinations were performed in an observational study of 48 malaria patients and 62 healthy participants across age groups in Gabon. Results IVC collapsibility index (CI) ≥ 50% on enrolment reflecting intravascular fluid depletion was associated with an increased number of clinical signs of hypovolaemia in severe and uncomplicated malaria. With exception of dry mucous membranes, IVC-CI correlated with most clinical signs of hypovolaemia, most notably sunken eyes (r = 0.35, p = 0.0001) and prolonged capillary refill (r = 0.35, p = 0.001). IVC-to-aorta ratio ≤ 0.8 was not associated with any clinical signs of hypovolaemia on enrolment. Among malaria patients, a B-pattern on enrolment reflecting interstitial fluid was associated with dyspnoea (p = 0.0003), crepitations and SpO2 ≤ 94% (both p < 0.0001), but not tachypnoea (p = 0.069). Severe malaria patients had increased IVC-CI (p < 0.0001) and more B-patterns (p = 0.004) on enrolment relative to uncomplicated malaria and controls. Conclusion In malaria patients, POCUS of the IVC and lungs may improve the assessment of volume status and detect early oedema, which could help to manage fluids in these patients.

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“…Several studies have demonstrated the feasibility of medical students using POCUS and have included teaching multiple POCUS applications to medical students simultaneously [2,4,5]. However, there are few studies demonstrating medical students' ability to accurately perform POCUS on pediatric patients and these studies have typically included one POCUS application taught at a time [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Can Medical Students Learn and Perform POCUS in the Pediatric Emergency Department? Implementation of a Short Curriculum

Cooper

Jones

Pascual

et al. 2022

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Purpose: To determine medical student ability to accurately obtain and interpret POCUS exams of varying difficulty in the pediatric population after a short didactic and hands-on POCUS course. Methods: Five medical students were trained in four POCUS applications (bladder volume, long bone for fracture, limited cardiac for left ventricular function, & inferior vena cava collapsibility) and enrolled pediatric ED patients. Ultrasound-fellowship-trained emergency medicine physicians reviewed each scan for image quality and interpretation accuracy using the American College of Emergency Physicians’ quality assessment scale. We report acceptable scan frequency and medical student vs. Ultrasound-fellowship-trained emergency medicine physician interpretation agreement with 95% confidence intervals (CI). Results: Ultrasound-fellowship-trained emergency medicine physicians graded 51/53 bladder volume scans as acceptable (96.2%; 95% CI 87.3-99.0%) and agreed with 50/53 bladder volume calculations (94.3%; 95% CI 88.1-100%). Ultrasound-fellowship-trained emergency medicine physicians graded 35/37 long bone scans as acceptable (94.6%; 95% CI 82.3-98.5%) and agreed with 32/37 medical student long bone scan interpretations (86.5%; 95% CI 72.0-94.1%). Ultrasound-fellowship-trained emergency medicine physicians graded 116/120 cardiac scans as acceptable (96.7%; 95% CI 91.7-98.7%) and agreed with 111/120 medical student left ventricular function interpretations (92.5%; 95% CI 86.4-96.0%). Ultrasound-fellowship-trained emergency medicine physicians graded 99/117 inferior vena cava scans as acceptable (84.6%; 95% CI 77.0-90.0%) and agreed with 101/117 medical student interpretations of inferior vena cava collapsibility (86.3%; 95% CI 78.9-91.4%). Conclusions: Medical students demonstrated satisfactory ability within a short period of time in a range of POCUS scans on pediatric patients after a novel curriculum. This supports the incorporation of a formal POCUS education into medical school curricula and suggests that novice POCUS learners can attain a measure of competency in multiple applications after a short training course.

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Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

Cited by 6 publications

References 11 publications

Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment

Point-of-Care Noninvasive Technology for Pediatric Dehydration Assessment

Point-of-care ultrasound to assess volume status and pulmonary oedema in malaria patients

Can Medical Students Learn and Perform POCUS in the Pediatric Emergency Department? Implementation of a Short Curriculum

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