Empirically Derived Dehydration Scoring and Decision Tree Models for Children With Diarrhea: Assessment and Internal Validation in a Prospective Cohort Study in Dhaka, Bangladesh

Levine, Adam C.; Glavis-Bloom, Justin; Modi, Payal; Nasrin, Sabiha; Rege, Soham; Schmid, Christopher H.; Alam, Nur

doi:10.9745/ghsp-d-15-00097

Cited by 31 publications

(42 citation statements)

References 28 publications

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“…Additionally, previous research has identified the presence of a statistical interaction between general appearance and sunken eyes, whereby sunken eyes are a strong predictor of dehydration status in children with a normal general appearance but a weak predictor in children with a lethargic general appearance. 22 However, the presence of tears might be difficult to assess in very young infants, who might not begin to form tears until the age of 2 months. Diarrhoea is very uncommon in this age group, however, as most children younger than 3 months in low-income countries are exclusively breastfed and therefore not routinely exposed to enteral pathogens.…”

Section: Discussionmentioning

confidence: 99%

“…Assuming a sensitivity of about 85% for the assessment of severe dehydration on the basis of the performance of the DHAKA score in its derivation population, with a power (type II error) of 80%, an α (type I error) of 0·05, and a 10% prevalence of severe dehydration, we estimated a sample size of at least 490 patients to ensure 95% CI around our test characteristics of less than 10%. 22,25 To allow for up to 10% loss to follow-up, we planned to enrol at least 540 patients in our study.…”

Section: Methodsmentioning

confidence: 99%

“…In response, the Dehydration: Assessing Kids Accurately (DHAKA) study 22 empirically derived and internally validated a new clinical score for assessing dehydration in children with acute diarrhoea in a low-income country (figure 2). In this study, we sought to externally validate the DHAKA score and compare its accuracy and reliability to the IMCI algorithm.…”

Section: Introductionmentioning

confidence: 99%

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External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

Levine

Glavis-Bloom

Modi

et al. 2016

The Lancet Global Health

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Summary Background Dehydration due to diarrhoea is a leading cause of child death worldwide, yet no clinical tools for assessing dehydration have been validated in resource-limited settings. The Dehydration: Assessing Kids Accurately (DHAKA) score was derived for assessing dehydration in children with diarrhoea in a low-income country setting. In this study, we aimed to externally validate the DHAKA score in a new population of children and compare its accuracy and reliability to the current Integrated Management of Childhood Illness (IMCI) algorithm. Methods DHAKA was a prospective cohort study done in children younger than 60 months presenting to the International Centre for Diarrhoeal Disease Research, Bangladesh, with acute diarrhoea (defined by WHO as three or more loose stools per day for less than 14 days). Local nurses assessed children and classified their dehydration status using both the DHAKA score and the IMCI algorithm. Serial weights were obtained and dehydration status was established by percentage weight change with rehydration. We did regression analyses to validate the DHAKA score and compared the accuracy and reliability of the DHAKA score and IMCI algorithm with receiver operator characteristic (ROC) curves and the weighted κ statistic. This study was registered with ClinicalTrials.gov, number NCT02007733. Findings Between March 22, 2015, and May 15, 2015, 496 patients were included in our primary analyses. On the basis of our criterion standard, 242 (49%) of 496 children had no dehydration, 184 (37%) of 496 had some dehydration, and 70 (14%) of 496 had severe dehydration. In multivariable regression analyses, each 1-point increase in the DHAKA score predicted an increase of 0·6% in the percentage dehydration of the child and increased the odds of both some and severe dehydration by a factor of 1·4. Both the accuracy and reliability of the DHAKA score were significantly greater than those of the IMCI algorithm. Interpretation The DHAKA score is the first clinical tool for assessing dehydration in children with acute diarrhoea to be externally validated in a low-income country. Further validation studies in a diverse range of settings and paediatric populations are warranted. Funding National Institutes of Health Fogarty International Center.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

Levine

Glavis-Bloom

Modi

et al. 2016

The Lancet Global Health

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“…These studies were originally designed to derive and validate a clinical dehydration tool for use in low-resource settings. Each was a prospective cohort study; detailed study protocols have been previously published [16,17]. Ethical approval was obtained from the International Centre for Diarrhoeal Disease Research (icddr,b), Bangladesh Ethical Review Committee, and the Rhode Island Hospital (Lifespan) Institutional Review Board.…”

Section: Methodsmentioning

confidence: 99%

“…The current study aims to understand if boys and girls with acute diarrheal illness differ in severity on presentation, based on a planned secondary analysis of a large data set from Bangladesh. The purpose of the original study was to develop and validate the dehydration: assessing kids accurately (DHAKA) score, a clinical decision tool to assess and guide the treatment of dehydrated children aged 5 years or younger in low resource settings [16,17]. We hypothesize that within this data set, boys are overrepresented due to gendered cultural norms in this region regarding health-seeking behavior that favor medical care for male children, and that boys, therefore, will have less severe dehydration than girls upon presentation.…”

Section: Introductionmentioning

confidence: 99%

Sex and Gender Differences in Acute Pediatric Diarrhea: A Secondary Analysis of the DHAKA Study

Jarman

Long

Robertson

et al. 2018

JEGH

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Pediatric diarrheal disease is a significant source of morbidity and mortality in the developing world. While several studies have demonstrated an increased incidence of diarrheal illness in boys compared with girls in low-and middle-income countries (LMIC), the reasons for this difference are unclear. This secondary analysis of the dehydration: assessing kids accurately (DHAKA) derivation and validation studies included children aged <5 years old with acute diarrhea in Dhaka, Bangladesh. The dehydration status was established by percentage weight change with rehydration. Multivariable regression was used to compare percent dehydration, while controlling for differences in age and nutritional status. In this cohort, a total of 1396 children were analyzed; 785 were male (56.2%) and 611 were female (43.8%). Girls presenting with diarrhea were older than boys (median age 17 months vs. 15 months, p = 0.02) and had significantly more malnutrition than boys, even when controlled for age (mean mid-upper arm circumference 134.2 mm vs. 136.4 mm, p < 0.01). The mean percent dehydration did not differ between boys and girls after controlling for age and nutrition status (p = 0.25). Although girls did have higher rates of malnutrition than boys, measures of diarrhea severity were similar between the two groups, arguing against a cultural bias in care-seeking behavior that favors boys.

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Carotid Flow Time Test Performance for the Detection of Dehydration in Children With Diarrhea

MacKenzie

Nasrin

Atika

et al. 2017

J of Ultrasound Medicine

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Empirically Derived Dehydration Scoring and Decision Tree Models for Children With Diarrhea: Assessment and Internal Validation in a Prospective Cohort Study in Dhaka, Bangladesh

Cited by 31 publications

References 28 publications

External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study

Sex and Gender Differences in Acute Pediatric Diarrhea: A Secondary Analysis of the DHAKA Study

Carotid Flow Time Test Performance for the Detection of Dehydration in Children With Diarrhea

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