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Two minutes to save thousands of children each year

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DHAKA   Dehydration: Assess Kids Accurately

A simple new method for assessing dehydration from diarrhea, which kills hundreds of thousands of children each year worldwide, has proven accurate and reliable.

To properly treat young children with severe diarrhea, caregivers in clinics long on patients and short on resources need a quick and accurate way to assess the severity of dehydration.

After a study testing it with nearly 500 children in Bangladesh, the four-symptom "DHAKA" score is now the most tested method.

"The DHAKA score now has better evidence for its performance in assessing dehydration in a specifically low-income country setting than any other scale," said Dr. Adam Levine, associate professor of emergency medicine in the Warren Alpert Medical School of Brown University and lead author of the study in The Lancet Global Health.

"Looking at it from an evidence-based medicine point of view, it is better than anything else out there."

In a side-by-side comparison, the study showed that DHAKA, which stands for Dehydration: Assess Kids Accurately, was a significantly better predictor of dehydration severity in children under age five than the current standard, the World Health Organization's Integrated Management of Childhood Illness (IMCI) guidelines.

Continuous improvement of diagnostic methods is vital, explained Levine, who is also a physician in the Lifespan health system, because in hospitals and clinics where intravenous fluids and beds are in limited supply, it's imperative that those treatment resources be provided only to severely dehydrated children.

Children with moderate dehydration can be rehydrated orally. Moreover, mistaken overtreatment with IV fluids of only somewhat or non-dehydrated children can result in seizures or difficulty breathing.

Levine and colleagues including a team at the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh, derived the DHAKA score in 2014 by analyzing the cases of 770 children with diarrhea due to cholera and other serious intestinal infections.

The researchers statistically determined which clinical signs at intake best predicted dehydration severity.

They found four such symptoms that a nurse or doctor could observe within two minutes to make an accurate diagnosis:

- General appearance: Is the child restless or irritable, or lethargic or unconscious?

- Breathing: Is it normal or deep?

- Skin pinch: After a pinch, does skin snap right back or respond slowly, or very slowly?

- Tears: Does the child produce a normal volume, less than normal or none at all?

When applied retrospectively to the patients, the DHAKA score showed significant accuracy, sensitivity and specificity in identifying which child had no dehydration, moderate dehydration or severe dehydration.

The definitive measure is made by comparing a child's weight at intake and after full rehydration.


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