A comparison of the NIRUDAK models and WHO algorithm for dehydration assessment in older children and adults with acute diarrhoea: a prospective, observational study

Background Despite 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. Methods A 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). Findings 1580 patients were included in our primary analysis, of whom 921 (58 center dot 3%) were female and 659 (41 center dot 7%) male. The ORC was 0 center dot 74 (95% CI 0 center dot 71-0 center dot 77) for the CDST, 0 center dot 75 (0 center dot 71-0 center dot 78) for the simplified score, and 0 center dot 64 (0 center dot 61-0 center dot 67) for the WHO guidelines. The ICC was 0 center dot 98 (95% CI 0 center dot 97-0 center dot 98) for the CDST, 0 center dot 94 (0 center dot 93-0 center dot 95) for the simplified score, and 0 center dot 56 (0 center dot 52-0 center dot 60) for the WHO guidelines. Interpretation Use 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.

Automated summary

The study validated a clinical decision support tool and a simplified score for assessing dehydration severity in older children and adults with acute diarrhea. The CDST and simplified score showed higher accuracy and reliability compared to current WHO guidelines, potentially reducing morbidity and mortality for this common disease.