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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Prediction of severe disease in children with diarrhea in a resource-limited setting
PLoS ONE, Volume 8, No. 12, Article e82386, Year 2013
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Description
Objective: To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting. Methods: Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death. Results: The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93). Conclusions: While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings. © 2013 Levine et al.
Authors & Co-Authors
Levine, Adam
United States, Providence
The Warren Alpert Medical School
Munyaneza, Richard M.
Rwanda, Kigali
Rwanda Ministry of Health
Glavis-Bloom, Justin
United States, Providence
The Warren Alpert Medical School
Redditt, Vanessa
Canada, Toronto
University of Toronto
Cockrell, Hannah C.
United States, Providence
Brown University
Kalimba, Bantu
Rwanda
Kirehe Hospital
Kabemba, Valentin
Rwanda
Kirehe Hospital
Musavuli, Juvenal
Rwanda, Burera
Butaro Hospital
Gakwerere, Mathias
Rwanda, Burera
Butaro Hospital
De Charles Umurungi, Jean Paul
Australia, Sydney
Unsw Sydney
Shah, Sachita P.
United States, Seattle
Uw Medical Center – Montlake
Drobac, Peter C.
United States, Boston
Brigham and Women's Hospital
United States, Boston
Partners in Health
Statistics
Citations: 19
Authors: 12
Affiliations: 10
Identifiers
Doi:
10.1371/journal.pone.0082386
e-ISSN:
19326203
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cohort Study