Advertisement

Sonographic aorta/IVC cross-sectional area index for evaluation of dehydration in children

      Abstract

      Objective

      Current studies have not found sufficient evidence to encourage the use of ultrasound for assessing dehydration in children. We introduce a new sonographic parameter, the “aorta/inferior vena cava (IVC) cross-sectional area index” (Ao/IVCA) measured just inferior to the xiphoid process, for the effective evaluation of dehydration in children.

      Methods

      This is a prospective, observational study. We enrolled children who presented to the pediatric emergency department (PED) between May 2014 and January 2015. We measured the maximum diameter of the aorta from inner wall to inner wall, and the long and short axis diameters of IVC using a convex array transducer. Ao/IVCA was calculated and compared with aorta/IVC maximal diameter index (Ao/IVCD) and the clinical dehydration scale (CDS).

      Results

      A total of 34 children were enrolled. We found a statistically significant correlation between Ao/IVCA and CDS (R2 = 0.30; P <.001). Ao/IVCD did not correlate significantly with CDS (R2 = 0.08; P =.11). The ability of Ao/IVCA and Ao/IVCD to predict CDS ≥1 was assessed using the receiver operating characteristic analysis. The area under the receiver operating characteristic curve for Ao/IVCA was larger than that for Ao/IVCD (0.87 vs 0.75, P= .04). The cut-off value of Ao/IVCA that yielded the maximum value of Youden index was 1.81 (sensitivity: 72%, specificity: 89%).

      Conclusions

      Ao/IVCA might be a promising index for the assessment of dehydration. The diagnostic performance of Ao/IVCA for dehydration might be higher than that of the method that uses the maximum diameter of IVC and the aorta.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Steiner MJ
        • DeWalt DA
        • Byerley JS
        Is this child dehydrated?.
        JAMA. 2004; 291: 2746-2754
        • Freedman SB
        • Vandermeer B
        • Milne A
        • Hartling L
        • Pediatric Emergency Research Canada Gastroenteritis Study G
        Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis.
        J Pediatr. 2015; 166 ([e1-6]): 908-916
        • Chen L
        • Kim Y
        • Santucci KA
        Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration.
        Acad Emerg Med. 2007; 14: 841-845
        • Kosiak W
        • Swieton D
        • Piskunowicz M
        Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound--preliminary study.
        Am J Emerg Med. 2008; 26: 320-325
        • Chen L
        • Hsiao A
        • Langhan M
        • Riera A
        • Santucci KA
        Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis.
        Acad Emerg Med. 2010; 17: 1042-1047
        • Moretti R
        • Pizzi B
        Inferior vena cava distensibility as a predictor of fluid responsiveness in patients with subarachnoid hemorrhage.
        Neurocrit Care. 2010; 13: 3-9
        • Levine AC
        • Shah SP
        • Umulisa I
        • Munyaneza RB
        • Dushimiyimana JM
        • Stegmann K
        • et al.
        Ultrasound assessment of severe dehydration in children with diarrhea and vomiting.
        Acad Emerg Med. 2010; 17: 1035-1041
        • Modi P
        • Glavis-Bloom J
        • Nasrin S
        • Guy A
        • Chowa EP
        • Dvor N
        • et al.
        Accuracy of inferior vena cava ultrasound for predicting dehydration in children with acute diarrhea in resource-limited settings.
        PLoS One. 2016; 11
        • Jauregui J
        • Nelson D
        • Choo E
        • Stearns B
        • Levine AC
        • Liebmann O
        • et al.
        The BUDDY (bedside ultrasound to detect dehydration in youth) study.
        Crit Ultrasound J. 2014; 6: 15
        • Ng L
        • Khine H
        • Taragin BH
        • Avner JR
        • Ushay M
        • Nunez D
        Does bedside sonographic measurement of the inferior vena cava diameter correlate with central venous pressure in the assessment of intravascular volume in children?.
        Pediatr Emerg Care. 2013; 29: 337-341
        • Gorelick MH
        • Shaw KN
        • Murphy KO
        Validity and reliability of clinical signs in the diagnosis of dehydration in children.
        Pediatrics. 1997; 99E6
        • Friedman JN
        • Goldman RD
        • Srivastava R
        • Parkin PC
        Development of a clinical dehydration scale for use in children between 1 and 36 months of age.
        J Pediatr. 2004; 145: 201-207
        • Kinlin LM
        • Freedman SB
        Evaluation of a clinical dehydration scale in children requiring intravenous rehydration.
        Pediatrics. 2012; 129: e1211-e1219