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The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study.

Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, Shah SP - Crit Ultrasound J (2014)

Bottom Line: Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater.The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility.Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence 02912, RI, USA ; Division of Emergency Medicine, Harborview Medical Center, University of Washington, M/S 325 9th Avenue, Seattle 98104, WA, USA.

ABSTRACT

Background: Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department.

Methods: We prospectively enrolled a non-consecutive cohort of children ≤18 years old. Patient weight, ultrasound measurements of the IVC and Ao, and physician gestalt were recorded. The percent weight change from presentation to discharge was used to calculate the degree of dehydration. A weight change of ≥5% was considered clinically significant dehydration. Receiver operating characteristic (ROC) curves were constructed for each of the ultrasound measurements and physician gestalt. Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater. Intra-class correlation coefficients were calculated to assess the degree of inter-rater reliability between ultrasound observers.

Results: Of 113 patients, 10.6% had significant dehydration. The IVC/Ao ratio had an area under the ROC curve (AUC) of 0.72 (95% CI 0.53 to 0.91) and, with a cutoff of 0.8, produced a SN of 67% and a SP of 71% for the diagnosis of significant dehydration. The IVC collapsibility index of 50% had an AUC of 0.58 (95% CI 0.44 to 0.72) and, with a cutoff of 80% collapsibility, produced a SN of 83% and a SP of 42%. The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility. Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.

Conclusions: The ultrasound-measured IVC/Ao ratio is a modest predictor of significant dehydration in children. The inspiratory IVC collapse and physician gestalt were poor predictors of the actual level of dehydration in this study.

No MeSH data available.


Related in: MedlinePlus

Ultrasound image of the longitudinal inferior vena cava collapsibility in expiration above and inspiration below. IVC, inferior vena cava.
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Figure 3: Ultrasound image of the longitudinal inferior vena cava collapsibility in expiration above and inspiration below. IVC, inferior vena cava.

Mentions: For the long axis view of the IVC to assess collapsibility with inspiration, one of two techniques was used. The probe was either placed midline in the sagittal plane with the marker towards the patient's head or on the patient's right side, coronal plane, and mid-axillary line with the marker towards the head. The probe position was chosen based on where the study investigator felt the best view could be obtained using the two techniques previously described in the literature [22]-[25]. A 6-s video clip was recorded, and then still images during inspiration and expiration were obtained. Still images of the maximum and minimum diameter of the IVC were measured, 2 cm from the right atrium-caval junction at the diaphragm or near the level of the entry of the hepatic veins as described previously in the literature (see Figure 3) [26]-[28].


The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study.

Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, Shah SP - Crit Ultrasound J (2014)

Ultrasound image of the longitudinal inferior vena cava collapsibility in expiration above and inspiration below. IVC, inferior vena cava.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4233328&req=5

Figure 3: Ultrasound image of the longitudinal inferior vena cava collapsibility in expiration above and inspiration below. IVC, inferior vena cava.
Mentions: For the long axis view of the IVC to assess collapsibility with inspiration, one of two techniques was used. The probe was either placed midline in the sagittal plane with the marker towards the patient's head or on the patient's right side, coronal plane, and mid-axillary line with the marker towards the head. The probe position was chosen based on where the study investigator felt the best view could be obtained using the two techniques previously described in the literature [22]-[25]. A 6-s video clip was recorded, and then still images during inspiration and expiration were obtained. Still images of the maximum and minimum diameter of the IVC were measured, 2 cm from the right atrium-caval junction at the diaphragm or near the level of the entry of the hepatic veins as described previously in the literature (see Figure 3) [26]-[28].

Bottom Line: Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater.The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility.Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency Medicine, Warren Alpert Medical School, Brown University, Providence 02912, RI, USA ; Division of Emergency Medicine, Harborview Medical Center, University of Washington, M/S 325 9th Avenue, Seattle 98104, WA, USA.

ABSTRACT

Background: Prior research suggests that the ratio of the ultrasound-measured diameter of the inferior vena cava to the aorta correlates with the level of dehydration in children. This study was designed to externally validate this and to access the accuracy of the ultrasound measured inspiratory IVC collapse and physician gestalt to predict significant dehydration in children in the emergency department.

Methods: We prospectively enrolled a non-consecutive cohort of children ≤18 years old. Patient weight, ultrasound measurements of the IVC and Ao, and physician gestalt were recorded. The percent weight change from presentation to discharge was used to calculate the degree of dehydration. A weight change of ≥5% was considered clinically significant dehydration. Receiver operating characteristic (ROC) curves were constructed for each of the ultrasound measurements and physician gestalt. Sensitivity (SN) and specificity (SP) were calculated based on previously established cutoff points of the IVC/Ao ratio (0.8), the IVC collapsibility index of 50%, and a new cut off point of IVC collapsibility index of 80% or greater. Intra-class correlation coefficients were calculated to assess the degree of inter-rater reliability between ultrasound observers.

Results: Of 113 patients, 10.6% had significant dehydration. The IVC/Ao ratio had an area under the ROC curve (AUC) of 0.72 (95% CI 0.53 to 0.91) and, with a cutoff of 0.8, produced a SN of 67% and a SP of 71% for the diagnosis of significant dehydration. The IVC collapsibility index of 50% had an AUC of 0.58 (95% CI 0.44 to 0.72) and, with a cutoff of 80% collapsibility, produced a SN of 83% and a SP of 42%. The intra-class correlation coefficient was 0.83 for the IVC/Ao ratio and 0.70 for the IVC collapsibility. Physician gestalt had an AUC of 0.61 (95% CI 0.44 to 0.78) and, with a cutoff point of 5, produced a SN of 42% and a SP of 65%.

Conclusions: The ultrasound-measured IVC/Ao ratio is a modest predictor of significant dehydration in children. The inspiratory IVC collapse and physician gestalt were poor predictors of the actual level of dehydration in this study.

No MeSH data available.


Related in: MedlinePlus