The accuracy of clinical diagnosis for dehydration according to the integrated management of childhood illness

Abstract

Background Acute diarrheal disease causes over 5 milion deaths worldwide in children under 5 years old, mostly because of failure to detect and treat dehydration properly and immediately. Objective To determine the validity of clinical diagnosis of dehy- dration according to Integrated Management of Childhood Illness (IMCI) as a diagnostic test for dehydration in children under five years old. Methods A prospective observational study was done for clinical diagnosis in dehydration. Children aged 2 months-5 years old with diarrhea and or vomiting who visited the primary health centers in Yogyakarta were enrolled. Clinical diagnosis was made by a trained IMCI nurses. Dehydration was defined as the presence of decreasing consciousness, very sunken eyes, slow reaction when offered a drink, and decreased skin elasticity. Ninety-five per- cents confidence intervals (CI) were calculated, and the signifi- cance was assessed by X 2 . Results There were 148 children aged 2 months to 5 years old enrolled this study. Clinical dehydration used according to IMCI produced sensitivity of 91% (95% CI 83;98), specificity of 82% (95% CI 75;89), positive predictive value (PPV) of 70% (95% CI 58;77), negative predictive value (NPV) of 94% (95% CI 90;98), positive likehood ratio of 5.17 (95% CI 3.37;7.94), and negative likehood ratio of 0.11 (95% CI 0.04;0.27). Conclusion Clinical diagnosis for dehydration according to IMCI is sufficiently accurate as a diagnostic test for dehydration in chil- dren under 5 years old

Keywords

• clinical diagnosis
• dehydration
• integrated management of childhood illness