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Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time

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 p...

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Autores principales: Caruggi, Samuele, Rossi, Martina, De Giacomo, Costantino, Luini, Chiara, Ruggiero, Nicola, Salvatoni, Alessandro, Salvatore, Silvia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182472/
https://www.ncbi.nlm.nih.gov/pubmed/30345241
http://dx.doi.org/10.5223/pghn.2018.21.4.278
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author Caruggi, Samuele
Rossi, Martina
De Giacomo, Costantino
Luini, Chiara
Ruggiero, Nicola
Salvatoni, Alessandro
Salvatore, Silvia
author_facet Caruggi, Samuele
Rossi, Martina
De Giacomo, Costantino
Luini, Chiara
Ruggiero, Nicola
Salvatoni, Alessandro
Salvatore, Silvia
author_sort Caruggi, Samuele
collection PubMed
description 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.
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spelling pubmed-61824722018-10-19 Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time Caruggi, Samuele Rossi, Martina De Giacomo, Costantino Luini, Chiara Ruggiero, Nicola Salvatoni, Alessandro Salvatore, Silvia Pediatr Gastroenterol Hepatol Nutr Original Article 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. The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition 2018-10 2018-10-10 /pmc/articles/PMC6182472/ /pubmed/30345241 http://dx.doi.org/10.5223/pghn.2018.21.4.278 Text en Copyright © 2018 by The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Caruggi, Samuele
Rossi, Martina
De Giacomo, Costantino
Luini, Chiara
Ruggiero, Nicola
Salvatoni, Alessandro
Salvatore, Silvia
Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title_full Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title_fullStr Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title_full_unstemmed Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title_short Pediatric Dehydration Assessment at Triage: Prospective Study on Refilling Time
title_sort pediatric dehydration assessment at triage: prospective study on refilling time
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6182472/
https://www.ncbi.nlm.nih.gov/pubmed/30345241
http://dx.doi.org/10.5223/pghn.2018.21.4.278
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