Review: capillary refill time, abnormal skin turgor, and abnormal respiratory pattern are useful signs for detecting dehydration in children

摘要

Dehydration is associated with the leading causes of morbidity and mortality in children throughout the world.1 Nurses in various clinical contexts must routinely assess the hydration status of paediatric patients. Identifying the best indicators or combinations of indicators of children's hydration status will enable practitioners to optimise patient management and minimise unnecessary procedures.The review by Steiner et al gives credence to the use of some clinical signs when assessing children's hydrafion status. Although the authors did a thorough literature search, most of the 13 included studies had low methodological quality (unblinded non-independent comparison of tests with a valid gold standard in a selected sample of patients). The findings are current best evidence but should still be viewed with some caution.The findings are relevant to paediatric practitioners in both outpatient and inpatient settings. The review indicates that current assessment of hydration is extremely variable and may not be well founded. For example, practitioners often turn to parents for information on a child's illness, but parental report was found to be a poor indicator of children's hydration status.The review by Steiner et al showed that the clinical examination is the most important method of assessing hydration in children. Rating scales incorporating combinations of signs have been developed to expedite diagnosis2 but may not include the combinations this review has identified as being the most predictive of dehydration. Future efforts at developing scales or scoring systems should evaluate the accuracy of signs identified in this review using the best evaluative methods for diagnostic testing.