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