For patients aged 1 month to 18 y/o in a non-ICU setting, do standard tests or newer diagnostic tests allow an accurate diagnosis of dehydration when compared to a criterion standard (weight loss).
Databases include MEDLINE and EMBASE to be searched. Search criteria include age 1mo -18 y/o, non-ICU setting, hypovolemia, dehydration, intravascular volume depletion, and their respective variations to generate a broad search to not exclude any necessary articles. From 3/2003 - 9/2012. Update from previous systematic review, completed from 1/1966-4/2003. There will be no language restrictions. The search strategy is completed and will be available in the published abstract and article. The searches will be repeated prior to the final analysis and further studies included if they meet the review criteria for inclusion.
Types of study to be included
No restrictions on types of study design. However each study considered for inclusion will then undergo full quality assessment using an established methodological filter that has been consistently used and described in the "Rational Clinical Examination" series.
Condition or domain being studied
Dehydration assessment in children. Update from previous systematic review completed in 2004.
1mo - 18 y/o in a non-ICU setting (Emergency Dept., outpatient clinic, hospital floor). The study will not be automatically excluded if some pediatric patients enrolled fall outside of above age range. For these studies, the amount of patients within the desired age range and the general consensus of the group will help determine inclusion or exclusion of the article.
Evaluation of standard diagnostic tests (signs, symptoms, and basic lab tests) and new diagnostic tests. Examples of standard diagnostic tests include prolonged capillary refill, abnormal skin turgor, abnormal respiratory pattern, sunken eyes, dry mucous membranes, cool extremities, weak pulses, absent tears, increased heart rate, sunken fontanelle, BUN value, Uric acid > 600 mmol/L, urine specific gravity etc. Newer diagnostic test include the use of ultrasound in the Emergency Department setting to assess changes in intravascular volume through evaluation of the heart.
Dehydration standard (weight loss). The difference between the rehydration weight and the acute weight divided by the rehydration weight and the acute weight divided by the best available gold standard of percentage of volume lost.
Overall those considered for inclusion must meet the PICO question mentioned in #15 of this page. The paper must then undergo a quality assessment mentioned on #22 and receive approval by two authors prior to acceptance into study. Those articles deemed of Level 4 or Level 5 quality will be excluded for lack of a good standard. Criteria have been already well defined in previous systematic review and is mentioned above. Primary difference is that a more mature search is used with this update and another database is included in the search (EMBASE). The other difference is working in accordance with PRISMA Statement from 2009 to ensure our systematic review meets these review criteria.
To evaluate the accuracy in assessing dehydration in pediatric patients in a non-ICU setting
Data extraction, (selection and coding)
Initially abstracts will be reviewed by two blinded authors. If either author believes the study assesses dehydration in pediatric patients the full text article will then be pulled for evaluation. Studies will be further selected if the researcher assessing the full text article believes it meets the above criteria in our PICO question. Two researchers will independently review each full text article and decide whether the article should be included in our review. If there is a disagreement between these two researchers, the publication will be brought before the group and a decision will be made between all researchers to reach a consensus agreement.
Risk of bias (quality) assessment
Risk bias will be assessed using standardized assessment tool, in which numerous questions are answered regarding each full text article. Currently in the process of selecting which one to use for our review. Both tools are in the form of an Excel document with numerous tabs reviewing pertinent issues of risk bias. Will serve as a check list and after researcher looks at how the study faired in this evaluation will classify the study accordingly.
Strategy for data synthesis
Precision of data to be reported as a range of K values obtained directly from published results. Two-by-two tables will be created from published information regarding accuracy and to calculate point estimates and 95% confidence intervals for the sensitivity, specificity, and likelihood ratios of each test. The 2x2 tables will be created to detect both 5% and 10% dehydration when data is available. If more then 2 studies evaluate a test, we will combine the results using a random-effects model. If only two studies evaluate a test a range of values will be provided.
Analysis of subgroups or subsets
The plan to is either submit the findings from the systematic review update to JAMA or Pediatrics. Either would be considered a leader in the field and appropriate for this topic.
Contact details for further information
111 Rosaline Lane, Durham NC 27713
Organisational affiliation of the review
University of North Carolina at Chapel Hill, Pediatric Medicine
Dr Nicholas Potisek, UNC-CH Hospital, Pediatrics Dr Michael Steiner, UNC-CH Hospital, Pediatrics Dr Stephanie Permar, UNC-CH Hospital, Pediatrics Dr Margaret Hall, UNC-CH Hospital, Pediatrics
Details of any existing review of the same topic by the same authors
An updated systematic review.
Steiner MJ, DeWalt DA, Byerley JS. Is this child dehydrated? JAMA. 2004; 291 (Vol. 22): 2746- 2754.
Anticipated or actual start date
04 September 2012
Anticipated completion date
15 November 2012
All responsibilities are handled by UNC-Chapel Hill Hospitals, Field of Pediatrics.
Conflicts of interest
United States of America
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Child; Dehydration; Diagnostic Tests, Routine; Humans; Infant; Sensitivity and Specificity
Date of registration in PROSPERO
05 October 2012
Date of publication of this revision
05 October 2012
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.