Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea.
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 managem...
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ftdoajarticles:oai:doaj.org/article:8842fd467f7d4d05b0c57e49e9dbd1ab 2023-05-15T15:14:38+02:00 Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. Adam C Levine Meagan A Barry Monique Gainey Sabiha Nasrin Kexin Qu Christopher H Schmid Eric J Nelson Stephanie C Garbern Mahmuda Monjory Rochelle Rosen Nur H Alam 2021-03-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0009266 https://doaj.org/article/8842fd467f7d4d05b0c57e49e9dbd1ab EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0009266 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0009266 https://doaj.org/article/8842fd467f7d4d05b0c57e49e9dbd1ab PLoS Neglected Tropical Diseases, Vol 15, Iss 3, p e0009266 (2021) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2021 ftdoajarticles https://doi.org/10.1371/journal.pntd.0009266 2022-12-31T10:37:36Z 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 15 3 e0009266 |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Adam C Levine Meagan A Barry Monique Gainey Sabiha Nasrin Kexin Qu Christopher H Schmid Eric J Nelson Stephanie C Garbern Mahmuda Monjory Rochelle Rosen Nur H Alam Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
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. |
format |
Article in Journal/Newspaper |
author |
Adam C Levine Meagan A Barry Monique Gainey Sabiha Nasrin Kexin Qu Christopher H Schmid Eric J Nelson Stephanie C Garbern Mahmuda Monjory Rochelle Rosen Nur H Alam |
author_facet |
Adam C Levine Meagan A Barry Monique Gainey Sabiha Nasrin Kexin Qu Christopher H Schmid Eric J Nelson Stephanie C Garbern Mahmuda Monjory Rochelle Rosen Nur H Alam |
author_sort |
Adam C Levine |
title |
Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
title_short |
Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
title_full |
Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
title_fullStr |
Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
title_full_unstemmed |
Derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
title_sort |
derivation of the first clinical diagnostic models for dehydration severity in patients over five years with acute diarrhea. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2021 |
url |
https://doi.org/10.1371/journal.pntd.0009266 https://doaj.org/article/8842fd467f7d4d05b0c57e49e9dbd1ab |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 15, Iss 3, p e0009266 (2021) |
op_relation |
https://doi.org/10.1371/journal.pntd.0009266 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0009266 https://doaj.org/article/8842fd467f7d4d05b0c57e49e9dbd1ab |
op_doi |
https://doi.org/10.1371/journal.pntd.0009266 |
container_title |
PLOS Neglected Tropical Diseases |
container_volume |
15 |
container_issue |
3 |
container_start_page |
e0009266 |
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1766345070919811072 |