Observational studyThe Lancet. Global health2023
A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study.
Observational study in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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9 citing papers in PubMed.
- Health Care Providers' Perspectives of Clinical Decision Support Tools for Pediatric Sepsis in Bangladesh: Qualitative Study.JMIR formative research · 2025Article
- Cholera rapid diagnostic tests at the host-microbe interface: Key Considerations for Global Deployments.medRxiv : the preprint server for health sciences · 2025Article
- Comparing the predictive discrimination of machine learning models for ordinal outcomes: A case study of dehydration prediction in patients with acute diarrhea.PLOS digital health · 2025Article
- Article
- Etiology of Severely Dehydrating Diarrheal Illness in Infants and Young Children Residing in Low- and Middle-Income Countries.Open forum infectious diseases · 2024Article
- Point of care lactate for differentiating septic shock from hypovolemic shock in non-ICU settings: a prospective observational study.The Lancet regional health. Southeast Asia · 2024Article
- Phage predation, disease severity and pathogen genetic diversity in cholera patients.bioRxiv : the preprint server for biology · 2024Article
- Indian Shot (Journal of inflammation research · 2024Article
- Chemico-pharmacological evaluations of the dwarf elephant ear (Frontiers in pharmacology · 2024Article
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Abstract
backgroundDespite the importance of accurate and rapid assessment of hydration status in patients with acute diarrhoea, no validated tools exist to help clinicians assess dehydration severity in older children and adults. The aim of this study is to validate a clinical decision support tool (CDST) and a simplified score for dehydration severity in older children and adults with acute diarrhoea (both developed during the NIRUDAK study) and compare their accuracy and reliability with current WHO guidelines.
methodsA random sample of patients aged 5 years or older presenting with diarrhoea to the icddr,b Dhaka Hospital in Bangladesh between Jan 30 and Dec 13, 2022 were included in this prospective cohort study. Patients with fewer than three loose stools per day, more than 7 days of symptoms, previous enrolment in the study, or a diagnosis other than acute gastroenteritis were excluded. Patients were weighed on arrival and assessed separately by two nurses using both our novel clinical tools and WHO guidelines. Patients were weighed every 4 h to determine their percent weight change with rehydration, our criterion standard for dehydration. Accuracy for the diagnosis of dehydration category (none, some, or severe) was assessed using the ordinal c-index (ORC). Reliability was assessed by comparing the prediction of severe dehydration from each nurse's independent assessment using the intraclass correlation coefficient (ICC).
findings1580 patients were included in our primary analysis, of whom 921 (58·3%) were female and 659 (41·7%) male. The ORC was 0·74 (95% CI 0·71-0·77) for the CDST, 0·75 (0·71-0·78) for the simplified score, and 0·64 (0·61-0·67) for the WHO guidelines. The ICC was 0·98 (95% CI 0·97-0·98) for the CDST, 0·94 (0·93-0·95) for the simplified score, and 0·56 (0·52-0·60) for the WHO guidelines.
interpretationUse of our CDST or simplified score by clinicians could reduce undertreatment and overtreatment of older children and adults with acute diarrhoea, potentially reducing morbidity and mortality for this common disease.
fundingUS National Institutes of Health. TRANSLATION: For the Bangla translation of the abstract see Supplementary Materials section.
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