Evaluation of WHO criteria to determine degree of dehydration in children with acute diarrhea
Keywords:
WHO criteria, acute diarrhea, dehydration, fluid deficit, sensitivity, specificity, agreement
Abstract
Objective To evaluate the diagnostic accuracy and agreementbetween the 1980 and 1990 WHO criteria for determining the de-
gree of dehydration in children with acute diarrhea.
Methods This prospective study was conducted in two hospitals
from October 2002 to February 2003. Clinical signs of dehydration
all patients were recorded. The degree of dehydration based on
the 1980 and 1990 WHO criteria was determined and compared
with fluid deficit measured by the difference of body weight on ad-
mission and on discharge. Chi-square test and kappa value analy-
ses were performed. Sensitivity, specificity, predictive values, and
accuracy of each WHO criteria were assessed. The prevalence of
dehydration was also determined.
Results Sixty-five patients, comprising 40 boys and 25 girls, were
studied. There was a significant difference between the two WHO
criteria in differentiating between dehydration and non-dehydra-
tion (P<0.05). Based on the 1980 WHO criteria the prevalence of
dehydration was 62.2%. Its sensitivity, specificity, and accuracy in
diagnosing dehydration were 100.0%, 55.5%, and 86.2%, respec-
tively. Based on the 1990 WHO criteria, the prevalence of dehy-
dration was 60.0%. Its sensitivity, specificity, and accuracy in diag-
nosing dehydration were 94.9%, 46.1%, and 75.4%, respectively.
There was also a significant difference between both criteria in
determining severe dehydration (P<0.05). Based on the 1980 cri-
teria, the prevalence of severe dehydration was 15.4%. Its sensi-
tivity, specificity, and accuracy in diagnosing severe dehydration
were 30.0%, 94.5%, and 84.6%, respectively. Based on the 1990
criteria, these results were 40.0%, 94.5%, and 86.2%, respectively.
The prevalence was 15.4%. Kappa value comparing the two WHO
criteria was 0.852 in diagnosing dehydration and 0.915 in diag-
nosing severe dehydration. There was no significant difference
between the two criteria in their sensitivity and specificity (P>0.05).
Conclusion Both WHO criteria can be applied to determine de-
hydration in patients with acute diarrhea, although we feel that the
1990 criteria is simpler
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Proceedings of Pendidikan Kedokteran Berkelanjutan
Ilmu Kesehatan Anak XLV. Jakarta: FKUI; 2002. p.
141-5.
3. Adelman RD, Solhung MJ. Pathophysiology of body
fluids and fluid therapy. In: Behrman RE, Kliegman
RM, Jenson HB, editros. Nelson textbook of pediat-
rics. 16 th ed. Philadelphia: Saunders; 2000. p. 211–23.
4. Sinuhaji AB. Patofisiologi dan tatalaksana diare akut
pada neonatus dan bayi. In: Pasaribu S, Lubis M, Lubis
B, Akbar K, Saputra AM, editors. Penatalaksanaan
diare pada bayi dan neonatus. Proceedings of
Pendidikan Kedokteran Berkelanjutan, Ilmu Kesehatan
Anak FK USU; 1999 Nov 22; Medan, Indonesia.
5. Sinuhaji AB. Prinsip umum pengobatan cairan
parenteral pada bayi dan anak. Presented at Simposium
Penatalaksanan Terapi Cairan pada Anak IDAI SU/
BIKA; 2000 Apr 22; Medan, Indonesia.
6. American Academy of Pediatrics Provisional Commit-
tee on Quality Improvement, Subcommittee on Acute
Gastroenteritis. Practice parameter: the management
of acute gastroenteritis in young children. Pediatrics
1996;97:424–33.
7. Gorelick MH, Shaw KN, Murphy KO. Validity and
reliability of clinical signs in the diagnosis of dehydra-
tion in children. Pediatrics 1997;99:e6.
8. Suharyono, Boediarso A, Halimun EM, editors.
Gastroenterologi Anak Praktis. Jakarta : FKUI; 1988.
p. 59-60.
9. World Health Organization. A manual for the treat-
ment of acute diarrhoea. Geneva, Switzerland:
Pogramme for control of diarrhoeal diseases. WHO/
CDD/SER/80.2.
10. Siregar AA, Lubis A, Sutanto AH, et al. Perbandingan
scoring system WHO (1980) dan Maurice King (1974)
pada anak dengan gastroenteritis dan dehidrasi di
bagian Ilmu Kesehatan Anak FK – USU / RS. Dr.
Pirngadi Medan. Medika 1987;1:80–6.
11. World Health Organization. A manual for the treat-
ment of diarrhoea. For use by physicians and other se-
nior health workers. Geneva, Switzerland: Programme
for the control of diarrhoeal diseases. WHO/CDD/SER/
80.2.Rev.2.1990.
12. Tumbelaka AR, Abdoerrachman MH, Latief A,
Abdulsalam M, Darwis D. Pengukuran dalam pe-
nelitian. In: Sastroasmoro S, Ismael S, editors. Dasar–
dasar metodologi penelitian klinis. 2nd edition. Jakarta:
Sagung Seto; 2002. p. 49-66
13. Mackenzie A, Shan F, Barnes G. Clinical signs of de-
hydration in children. Lancet 1989;ii:1529-30.
14. Armon K, Stephenson T, MacFaul R, Eccleston P,
Werneke U. An evidence and consensus based guide-
line for acute diarrhoea management. Arch Dis Child
2001;85:132-42.
15. Duggan C, Refat M, Hashem M, Wolff M, Fayad I,
Santosham M. How valid are clinical signs of dehy-
dration in infants? J Pediatr Gastroenterol Nutr
1996;22:56-61.
16. World Health Organization. Management of the child
with a serious infection or severe malnutrition. Guide-
lines for care at the first-referral level in developing
countries. Geneva, Switzerland: Department of child
and adolescent health and development WHO; 2000.
Published
2016-10-10
How to Cite
1.
Sari S, Supriatmo S, Margaretha S, Nafianti S, Hasibuan B, Sinuhaji A. Evaluation of WHO criteria to determine degree of dehydration in children with acute diarrhea. PI [Internet]. 10Oct.2016 [cited 27Apr.2024];45(2):76-0. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/804
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Received 2016-10-05
Accepted 2016-10-05
Published 2016-10-10
Accepted 2016-10-05
Published 2016-10-10
