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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Hypovolemia, Child
Michael J. Steiner, Darren A. DeWalt, Julie S. Byerley
Four studies evaluated acidosis as a test for dehydration.37,38,40,43 Most patients...

Topics Discussed: dehydration, diagnostic process, hypovolemia, pediatrics, summarizing the evidence

Excerpt: "Porter et al13 evaluated the agreement between parental observation of examination signs and the signs elicited by trained ED nurses. The value demonstrated substantial agreement beyond chance when assessing for a sunken anterior fontanelle ( = 0.73) and presence of cool extremities ( = 0.70). There was moderate agreement on general appearance ( = 0.46), presence of sunken eyes ( = 0.49), absence of tears ( = 0.57), and presence of dry mouth ( = 0.52).Three studies evaluated the accuracy of history-taking in assessing dehydration.13,35,37 All 3 of these studies evaluated history of low urine output as a test for dehydration. In the pooled analysis, low urine output did not increase the likelihood of 5% dehydration (LR, 1.3; 95% CI, 0.9-1.9). Porter et al13 showed that a history of vomiting, diarrhea, decreased oral intake, reported low urine output, a previous trial of clear liquids, and having seen another clinician during the illness before presenting to the ED yielded LRs that lacked utility in the assessment of dehydration. However, their data did suggest that children who had not been previously evaluated by a physician during the illness might be less likely to be dehydrated on presentation (LR, 0.09; 95% CI, 0.01-1.4). Similarly, parental report of a normal urine output decreases the likelihood of dehydration (Gorelick et al35 reported an LR of 0.27 [95% CI, 0.14-0.51] and Porter et al13 reported an LR of 0.16 [95% CI, 0.01-2.5])...."
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