Derivation and Internal Validation of a Score to Predict Dehydration Severity in Patients over 5 Years with Acute Diarrhea

2021 ◽  
Author(s):  
Meagan A. Barry ◽  
Kexin Qu ◽  
Monique Gainey ◽  
Christopher H. Schmid ◽  
Stephanie Garbern ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Acute Diarrhea ◽  
Diarrheal Disease ◽  
Characteristic Curve ◽  
Clinical Signs ◽  
Scoring Systems ◽  
Diarrhoeal Disease ◽  
Severe Dehydration ◽  
Internal Validation ◽  
Oral Rehydration

Diarrheal disease accounts for more than one million deaths annually in patients over 5 years of age. Although most patients can be managed with oral rehydration solution, patients with severe dehydration require resuscitation with intravenous fluids. Scoring systems to assess dehydration have been empirically derived and validated in children under 5 years, but none have been validated for patients over 5 years. In this study, a prospective cohort of 2,172 patients over 5 years presenting with acute diarrhea to International Centre for Diarrhoeal Disease Research, Dhaka Hospital, Bangladesh, were assessed for clinical signs of dehydration. The percent difference between presentation and posthydration stable weight determined severe (≥ 9%), some (3–9%), or no (< 3%) dehydration. An ordinal regression model was derived using clinical signs and demographics and was then converted to a 13-point score to predict none (score of 0–3), some (4–6), or severe (7–13) dehydration. The Novel, Innovative Research for Understanding Dehydration in Adults and Kids (NIRUDAK) Score developed by our team included age, sex, sunken eyes, radial pulse, respiration depth, skin turgor, and vomiting episodes in 24 hours. Accuracy of the NIRUDAK Score for predicting severe dehydration, as measured by the area under the receiver operating characteristic curve, was 0.76 (95% confidence interval = 0.73–0.78), with a sensitivity of 0.78 and a specificity of 0.61. Reliability was also robust, with an Inter-Class Correlation Coefficient of 0.88 (95% confidence interval = 0.84–0.91). This study represents the first empirically derived and internally validated scoring system for assessing dehydration in children ≥ 5 years and adults with acute diarrhea in a resource-limited setting.

scholarly journals Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea

2021 ◽  
Vol 15 (3) ◽  
pp. e0009266
Author(s):  
Adam C. Levine ◽  
Meagan A. Barry ◽  
Monique Gainey ◽  
Sabiha Nasrin ◽  
Kexin Qu ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Diarrheal Disease ◽  
Characteristic Curve ◽  
World Health ◽  
Simplified Model ◽  
Full Model ◽  
Low Resource Settings ◽  
Low Resource ◽  
Clinical Diagnostic ◽  
Diagnostic Models

Diarrheal diseases lead to an estimated 1.3 million deaths each year, with the majority of those deaths occurring in patients over five years of age. As the severity of diarrheal disease can vary widely, accurately assessing dehydration status remains the most critical step in acute diarrhea management. The objective of this study is to empirically derive clinical diagnostic models for assessing dehydration severity in patients over five years with acute diarrhea in low resource settings. We enrolled a random sample of patients over five years with acute diarrhea presenting to the icddr,b Dhaka Hospital. Two blinded nurses independently assessed patients for symptoms/signs of dehydration on arrival. Afterward, consecutive weights were obtained to determine the percent weight change with rehydration, our criterion standard for dehydration severity. Full and simplified ordinal logistic regression models were derived to predict the outcome of none (<3%), some (3–9%), or severe (>9%) dehydration. The reliability and accuracy of each model were assessed. Bootstrapping was used to correct for over-optimism and compare each model’s performance to the current World Health Organization (WHO) algorithm. 2,172 patients were enrolled, of which 2,139 (98.5%) had complete data for analysis. The Inter-Class Correlation Coefficient (reliability) was 0.90 (95% CI = 0.87, 0.91) for the full model and 0.82 (95% CI = 0.77, 0.86) for the simplified model. The area under the Receiver-Operator Characteristic curve (accuracy) for severe dehydration was 0.79 (95% CI: 0.76–0.82) for the full model and 0.73 (95% CI: 0.70, 0.76) for the simplified model. The accuracy for both the full and simplified models were significantly better than the WHO algorithm (p<0.001). This is the first study to empirically derive clinical diagnostic models for dehydration severity in patients over five years. Once prospectively validated, the models may improve management of patients with acute diarrhea in low resource settings.

scholarly journals Evaluation of WHO criteria to determine degree of dehydration in children with acute diarrhea

2016 ◽  
Vol 45 (2) ◽  
pp. 76
Author(s):  
Suprawita Sari ◽  
Supriatmo Supriatmo ◽  
S L Margaretha ◽  
S Nafianti ◽  
B Hasibuan ◽  
...  
Keyword(s):  
Acute Diarrhea ◽  
Clinical Signs ◽  
Severe Dehydration ◽  
Chi Square ◽  
Predictive Values ◽  
Who Criteria ◽  
Significant Difference ◽  
Kappa Value ◽  
The Difference ◽  
Sensitivity Specificity

Objective To evaluate the diagnostic accuracy and agreementbetween the 1980 and 1990 WHO criteria for determining the de-gree of dehydration in children with acute diarrhea.Methods This prospective study was conducted in two hospitalsfrom October 2002 to February 2003. Clinical signs of dehydrationall patients were recorded. The degree of dehydration based onthe 1980 and 1990 WHO criteria was determined and comparedwith fluid deficit measured by the difference of body weight on ad-mission and on discharge. Chi-square test and kappa value analy-ses were performed. Sensitivity, specificity, predictive values, andaccuracy of each WHO criteria were assessed. The prevalence ofdehydration was also determined.Results Sixty-five patients, comprising 40 boys and 25 girls, werestudied. There was a significant difference between the two WHOcriteria in differentiating between dehydration and non-dehydra-tion (P<0.05). Based on the 1980 WHO criteria the prevalence ofdehydration was 62.2%. Its sensitivity, specificity, and accuracy indiagnosing dehydration were 100.0%, 55.5%, and 86.2%, respec-tively. Based on the 1990 WHO criteria, the prevalence of dehy-dration was 60.0%. Its sensitivity, specificity, and accuracy in diag-nosing dehydration were 94.9%, 46.1%, and 75.4%, respectively.There was also a significant difference between both criteria indetermining severe dehydration (P<0.05). Based on the 1980 cri-teria, the prevalence of severe dehydration was 15.4%. Its sensi-tivity, specificity, and accuracy in diagnosing severe dehydrationwere 30.0%, 94.5%, and 84.6%, respectively. Based on the 1990criteria, these results were 40.0%, 94.5%, and 86.2%, respectively.The prevalence was 15.4%. Kappa value comparing the two WHOcriteria was 0.852 in diagnosing dehydration and 0.915 in diag-nosing severe dehydration. There was no significant differencebetween the two criteria in their sensitivity and specificity (P>0.05).Conclusion Both WHO criteria can be applied to determine de-hydration in patients with acute diarrhea, although we feel that the1990 criteria is simpler

scholarly journals Benefits of domperidone in ambulatory acute diarrhea with severe vomiting

2007 ◽  
Vol 47 (5) ◽  
pp. 207
Author(s):  
Irene A. O. ◽  
Achirul Bakri ◽  
Erial Bahar ◽  
Rusdi Ismail
Keyword(s):  
Treatment Group ◽  
Side Effects ◽  
Acute Diarrhea ◽  
Diarrheal Disease ◽  
Control Group ◽  
Placebo Control ◽  
Severe Dehydration ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Placebo Control Group

Background Recently, most patients with diarrheal disease (DD)cases are hospitalized not due to severe dehydration, but due tosevere vomiting which interferes with fluid and food intake. Useof anti-vomiting medicines is not recommended because of its“central” side effects. Domperidone has prokinetic and antiemeticeffects with only minimal extrapyramidal side effects.Objective To evaluate domperidone in preventing hospitalizationof DD patients in outpatient setting.Methods This randomized double blind, placebo-controlledclinical trial, was conducted from February to August 2005 atMohammad Hoesin Hospital, Palembang. We included patientsaged 6 to 59 months old with acute diarrhea who had vomited atleast 4 times in the last 24 hours, not in need of hospitalization,and agreed to participate. We excluded patients who had takenanti-vomiting drug, or those who had severe diseases, includingsevere malnutrition. The dose of domperidone was 1.25 mg per 5kg body weight.Results There were 183 subjects randomized, consisted of 91 whotook domperidone (treatment group) and 92 who took placebo(control group). The duration and decrease of vomiting frequencywere significantly different in favor of domperidone. Domperidoneprevented hospitalization significantly (P=0.001, OR=4.1, ARR= 20%, RRR=71%, NNT=5). No overt acute clinical side effectswere found.Conclusion Domperidone significantly shortened the duration anddecreased the frequency of vomiting in DD cases.

scholarly journals Deep-learning model for screening sepsis using electrocardiography

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Joon-myoung Kwon ◽  
Ye Rang Lee ◽  
Min-Seung Jung ◽  
Yoon-Ji Lee ◽  
Yong-Yeon Jo ◽  
...  
Keyword(s):  
Septic Shock ◽  
Deep Learning ◽  
Confidence Interval ◽  
Characteristic Curve ◽  
External Validation ◽  
Medical Emergency ◽  
Validation Dataset ◽  
Internal Validation ◽  
Significant Difference ◽  
Sepsis And Septic Shock

Abstract Background Sepsis is a life-threatening organ dysfunction and a major healthcare burden worldwide. Although sepsis is a medical emergency that requires immediate management, screening for the occurrence of sepsis is difficult. Herein, we propose a deep learning-based model (DLM) for screening sepsis using electrocardiography (ECG). Methods This retrospective cohort study included 46,017 patients who were admitted to two hospitals. A total of 1,548 and 639 patients had sepsis and septic shock, respectively. The DLM was developed using 73,727 ECGs from 18,142 patients, and internal validation was conducted using 7774 ECGs from 7,774 patients. Furthermore, we conducted an external validation with 20,101 ECGs from 20,101 patients from another hospital to verify the applicability of the DLM across centers. Results During the internal and external validations, the area under the receiver operating characteristic curve (AUC) of the DLM using 12-lead ECG was 0.901 (95% confidence interval, 0.882–0.920) and 0.863 (0.846–0.879), respectively, for screening sepsis and 0.906 (95% confidence interval (CI), 0.877–0.936) and 0.899 (95% CI, 0.872–0.925), respectively, for detecting septic shock. The AUC of the DLM for detecting sepsis using 6-lead and single-lead ECGs was 0.845–0.882. A sensitivity map revealed that the QRS complex and T waves were associated with sepsis. Subgroup analysis was conducted using ECGs from 4,609 patients who were admitted with an infectious disease, and the AUC of the DLM for predicting in-hospital mortality was 0.817 (0.793–0.840). There was a significant difference in the prediction score of DLM using ECG according to the presence of infection in the validation dataset (0.277 vs. 0.574, p < 0.001), including severe acute respiratory syndrome coronavirus 2 (0.260 vs. 0.725, p = 0.018). Conclusions The DLM delivered reasonable performance for sepsis screening using 12-, 6-, and single-lead ECGs. The results suggest that sepsis can be screened using not only conventional ECG devices but also diverse life-type ECG machines employing the DLM, thereby preventing irreversible disease progression and mortality.

scholarly journals Knowledge, attitude and practice of acute diarrheal disease and use of oral rehydration therapy among mothers of under five children

2019 ◽  
Vol 6 (5) ◽  
pp. 1976
Author(s):  
Achinta K. R. Mallick ◽  
Janki Bangari ◽  
Shalu S. Kumar ◽  
Himani Suyal
Keyword(s):  
Acute Diarrhea ◽  
Diarrheal Disease ◽  
Oral Rehydration Therapy ◽  
Bottle Feeding ◽  
Cross Sectional Survey ◽  
Oral Rehydration ◽  
Attitude And Practice ◽  
Correct Definition ◽  
Knowledge And Practice ◽  
Knowledge Attitude And Practice

Background: Acute diarrhea in children is among the commonest causes of outpatient and inpatient attendance in medical setup. Though enough has been done in imparting knowledge about diarrhea and its management, there is a gap between knowledge and practice in the population. Aim of the study is to assess the mother’s knowledge, attitude and practice about diarrhea in children.Methods: Cross-sectional survey, conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra.Results: Of the 305 mothers surveyed, their knowledge about diarrhea was good with 77.1% knowing correct definition, and most mothers knowing correctly about its mode of transmission, the positive role of good hygiene & sanitation, breast feeding and oral rehydration therapy (ORT) in prevention and management of acute diarrhea. However, their attitude and practice were found lacking, with higher rate of bottle feeding (59.3%) and lesser use of standard (46.3%) as well as home based (69.9%) ORT measures.Conclusions: There is discrepancy between the knowledge and practice. Hence, there is the need of sustained efforts in imparting both knowledge and practice among the population.

scholarly journals Nasogastric Drip Rehydration Therapy in Acute Diarrhea with Severe Dehydration

2019 ◽  
Vol 28 (3-4) ◽  
pp. 79-84 ◽  
Author(s):  
Syamsul Hidayat ◽  
Srie Enggar K. D. ◽  
Nancy Pardede ◽  
Rusdi Ismail
Keyword(s):  
Fluid Therapy ◽  
Acute Diarrhea ◽  
Oral Rehydration Solution ◽  
Severe Dehydration ◽  
Ringer Lactate ◽  
Small Children ◽  
Oral Rehydration ◽  
Practical Guidelines ◽  
Rehydration Solution ◽  
Lactate Solution

WHO recommended severe dehydration without shock in acute diarrhea to be rehydrated by nasogastric drips (NGD) of oral rehydration solution (oralit). In this respect the criteria of a still palpable and countable pulse, the absence of meteorism and absence of complication, the reverse warranting iv fluid therapy, can be used as practical guidelines to identify the patient "without shock". A clinical trial comparing the result of NGD oralit rehydration therapy to that of intravenous Ringer-lactate on small children with diarrhea and severe dehydration was conducted. Seventy jive patients admitted to the Department of Child Health Palembang General Hospital from January up to July 1986, aged 1 to 59 months, suffering from acute diarrhea with severe dehydration fulfilled to above mentioned criteria. Randomly 36 were assigned to NGD rehydration therapy using WHO standard ORS (in Indonesia is named as oralit) and 39 were rehydrated with iv Ringer lactate solution, given in four hours consisting of 40ml/kg BW, 30ml/kg BW, 20 ml/kg BW and 20ml/kg BW in the first, second, third and fourth hours respectively. Based on the failure rate of rehydration in the first four hours, the recurrence of dehydration after rehydration and the side effects of fluid therapy, it was concluded that acute diarrhea cases with severe dehydration who fulfilled the above mentioned criteria can be rehydrated by NGD oralit as effective and safe as by iv Ringer lactate.

scholarly journals Haemoconcentration as a predictor of severity in acute pancreatitis

2016 ◽  
Vol 4 (1) ◽  
pp. 3-7
Author(s):  
Tanka Prasad Bohara ◽  
Dimindra Karki ◽  
Anuj Parajuli ◽  
Shail Rupakheti ◽  
Mukund Raj Joshi
Keyword(s):  
Acute Pancreatitis ◽  
Pearson Correlation ◽  
Characteristic Curve ◽  
Scoring Systems ◽  
Cost Effective ◽  
Receiver Operator Characteristic Curve ◽  
First Episode ◽  
P Value ◽  
Receiver Operator Characteristic ◽  
Chi Square

Background: Acute pancreatitis is usually a mild and self-limiting disease. About 25 % of patients have severe episode with mortality up to 30%. Early identification of these patients has potential advantages of aggressive treatment at intensive care unit or transfer to higher centre. Several scoring systems are available to predict severity of acute pancreatitis but are cumbersome, take 24 to 48 hours and are dependent on tests that are not universally available. Haematocrit has been used as a predictor of severity of acute pancreatitis but some have doubted its role.Objectives: To study the significance of haematocrit in prediction of severity of acute pancreatitis.Methods: Patients admitted with first episode of acute pancreatitis from February 2014 to July 2014 were included. Haematocrit at admission and 24 hours of admission were compared with severity of acute pancreatitis. Mean, analysis of variance, chi square, pearson correlation and receiver operator characteristic curve were used for statistical analysis.Results: Thirty one patients were included in the study with 16 (51.61%) male and 15 (48.4%) female. Haematocrit at 24 hours of admission was higher in severe acute pancreatitis (P value 0.003). Both haematocrit at admission and at 24 hours had positive correlation with severity of acute pancreatitis (r: 0.387; P value 0.031 and r: 0.584; P value 0.001) respectively.Area under receiver operator characteristic curve for haematocrit at admission and 24 hours were 0.713 (P value 0.175, 95% CI 0.536 - 0.889) and 0.917 (P value 0.008, 95% CI 0.813 – 1.00) respectively.Conclusion: Haematocrit is a simple, cost effective and widely available test and can predict severity of acute pancreatitis.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 3-7

scholarly journals Accuracy of conventional and novel scoring systems in predicting severity and outcomes of acute pancreatitis: a retrospective study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Qing Wu ◽  
Jie Wang ◽  
Mengbin Qin ◽  
Huiying Yang ◽  
Zhihai Liang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Organ Failure ◽  
Scoring System ◽  
Characteristic Curve ◽  
Failure Prediction ◽  
Scoring Systems ◽  
Mortality Prediction ◽  
Severity Prediction ◽  
Index Of Severity ◽  
Glasgow Score

Abstract Background Recently, several novel scoring systems have been developed to evaluate the severity and outcomes of acute pancreatitis. This study aimed to compare the effectiveness of novel and conventional scoring systems in predicting the severity and outcomes of acute pancreatitis. Methods Patients treated between January 2003 and August 2020 were reviewed. The Ranson score (RS), Glasgow score (GS), bedside index of severity in acute pancreatitis (BISAP), pancreatic activity scoring system (PASS), and Chinese simple scoring system (CSSS) were determined within 48 h after admission. Multivariate logistic regression was used for severity, mortality, and organ failure prediction. Optimum cutoffs were identified using receiver operating characteristic curve analysis. Results A total of 1848 patients were included. The areas under the curve (AUCs) of RS, GS, BISAP, PASS, and CSSS for severity prediction were 0.861, 0.865, 0.829, 0.778, and 0.816, respectively. The corresponding AUCs for mortality prediction were 0.693, 0.736, 0.789, 0.858, and 0.759. The corresponding AUCs for acute respiratory distress syndrome prediction were 0.745, 0.784, 0.834, 0.936, and 0.820. Finally, the corresponding AUCs for acute renal failure prediction were 0.707, 0.734, 0.781, 0.868, and 0.816. Conclusions RS and GS predicted severity better than they predicted mortality and organ failure, while PASS predicted mortality and organ failure better. BISAP and CSSS performed equally well in severity and outcome predictions.

scholarly journals The use of score for neonatal acute physiology perinatal extention II (SNAPPE II) in predicting neonatal outcome in neonatal intensive care unit

2016 ◽  
Vol 45 (6) ◽  
pp. 241
Author(s):  
Mia R A ◽  
Risa Etika ◽  
Agus Harianto ◽  
Fatimah Indarso ◽  
Sylviati M Damanik
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Characteristic Curve ◽  
Newborn Care ◽  
Scoring Systems ◽  
Laboratory Observation ◽  
The Mean ◽  
Overall Mortality

Background Scoring systems which quantify initial risks have animportant role in aiding execution of optimum health services by pre-dicting morbidity and mortality. One of these is the score for neonatalacute physiology perinatal extention (SNAPPE), developed byRichardson in 1993 and simplified in 2001. It is derived of 6 variablesfrom the physical and laboratory observation within the first 12 hoursof admission, and 3 variables of perinatal risks of mortality.Objectives To assess the validity of SNAPPE II in predicting mor-tality at neonatal intensive care unit (NICU), Soetomo Hospital,Surabaya. The study was also undertaken to evolve the best cut-offscore for predicting mortality.Methods Eighty newborns were admitted during a four-month periodand were evaluated with the investigations as required for the specifi-cations of SNAPPE II. Neonates admitted >48 hours of age or afterhaving been discharged, who were moved to lower newborn care <24hours and those who were discharged on request were excluded. Re-ceiver operating characteristic curve (ROC) were constructed to derivethe best cut-off score with Kappa and McNemar Test.Results Twenty eight (35%) neonates died during the study, 22(82%) of them died within the first six days. The mean SNAPPE IIscore was 26.3+19.84 (range 0-81). SNAPPE II score of thenonsurvivors was significantly higher than the survivors(42.75+18.59 vs 17.4+14.05; P=0.0001). SNAPPE II had a goodperformance in predicting overall mortality and the first-6-daysmortality, with area under the ROC 0.863 and 0.889. The best cut-off score for predicting mortality was 30 with sensitivity 81.8%,specificity 76.9%, positive predictive value 60.0% and negativepredictive value 90.0%.Conclusions SNAPPE II is a measurement of illness severity whichcorrelates well with neonatal mortality at NICU, Soetomo Hospital.The score of more than 30 is associated with higher mortality

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