Does a standardised scoring system of clinical signs reduce variability between doctors' assessments of the potentially dehydrated child?

Journal of Paediatrics and Child Health
Damian RolandElaine M Pascoe

Abstract

Clinical assessment of dehydration in children is often inaccurate. We aimed to determine if a scoring system based on standardised clinical signs would reduce the variability between doctors' assessment of dehydration. A clinical scoring system was developed using seven physiological variables based on previously published research. Estimated percentage dehydration and severity scores were recorded for 100 children presenting to a Paediatric Emergency Department with symptoms of gastroenteritis and dehydration by three doctors of different seniority (resident medical officer, registrar and consultant). Agreement was measured using intra-class correlation coefficient (ICC) for percentage ratings and total clinical scores and kappa for individual characteristics. Estimated percentage dehydration ranged from 0-9%, mean 2.96%, across the three groups. Total clinical scores from 0-10, mean 2.20. There was moderate agreement amongst clinicians for the percentage dehydration (ICC 0.40). The level of agreement on the clinical scoring system was identical (ICC 0.40). Consultants gave statistically lower scores than the other two groups (Consultant (Con) vs. Resident P = 0.001, Con vs. Registrar P = 0.013). There was a marked difference...Continue Reading

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Citations

May 21, 2013·Postgraduate Medical Journal·Damian Roland
Nov 25, 2011·International Journal of Emergency Medicine·Damian RolandElaine Pascoe
Sep 28, 2014·Archives of Disease in Childhood·Susannah FlemingMatthew Thompson
Oct 18, 2016·Current Opinion in Clinical Nutrition and Metabolic Care·Lawrence E ArmstrongWilliam O Roberts
Jan 25, 2013·The American Journal of Clinical Nutrition·Samuel N CheuvrontMichael N Sawka
Jun 3, 2017·European Journal of Pediatrics·Anna FalszewskaHania Szajewska

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