Author Affiliations: Departments of Pediatrics (Drs Steiner, DeWalt, and Byerley) and Internal Medicine (Drs Steiner and DeWalt), University of North Carolina School of Medicine, and Robert Wood Johnson Clinical Scholars Program, University of North Carolina (Dr DeWalt), Chapel Hill. Dr Steiner is now at the Clinica Sierra Vista, Bakersfield, Calif.
The Rational Clinical Examination Section Editors: David L. Simel, MD, MHS,
Durham Veterans Affairs Medical Center and Duke University Medical Center, Durham, NC;
Drummond Rennie, MD, Deputy Editor, JAMA.
Context The ability to assess the degree of dehydration quickly and accurately
in infants and young children often determines patient treatment and disposition.
Objective To systematically review the precision and accuracy of symptoms, signs,
and basic laboratory tests for evaluating dehydration in infants and children.
Data Sources We identified 1561 potential articles by multiple search strategies
of the MEDLINE database through PubMed. Searches of bibliographies of retrieved
articles, the Cochrane Library, textbooks, and private collections of experts
in the field yielded an additional 42 articles.
Study Selection Twenty-six of 1603 reviewed studies contained original data on the precision
or accuracy of findings for the diagnosis of dehydration in young children
(1 month to 5 years).
Data Extraction Two of the 3 authors independently reviewed and abstracted data for
estimating the likelihood ratios (LRs) of diagnostic tests. We eliminated
13 of the 26 studies because of the lack of an accepted diagnostic standard
or other limitation in study design. The other 13 studies were included in
Data Synthesis The most useful individual signs for predicting 5% dehydration in children
are an abnormal capillary refill time (LR, 4.1; 95% confidence interval [CI],
1.7-9.8), abnormal skin turgor (LR, 2.5; 95% CI, 1.5-4.2), and abnormal respiratory
pattern (LR, 2.0; 95% CI, 1.5-2.7). Combinations of examination signs perform
markedly better than any individual sign in predicting dehydration. Historical
points and laboratory tests have only modest utility for assessing dehydration.
Conclusions The initial assessment of dehydration in young children should focus
on estimating capillary refill time, skin turgor, and respiratory pattern
and using combinations of other signs. The relative imprecision and inaccuracy
of available tests limit the ability of clinicians to estimate the exact degree
Steiner MJ, DeWalt DA, Byerley JS. Is This Child Dehydrated?. JAMA. 2004;291(22):2746-2754. doi:10.1001/jama.291.22.2746