Ultrasound of the Inferior Vena Cava (IVC) and Dehydration Status in Pediatric Emergency Patients
Condition: Dehydration
MeSH terms: Dehydration; Emergencies
Study type: Observational

Summary: 
      Objective: Although approximately 9% of patients presenting to a Pediatric Emergency
      Department (ED) are dehydrated, there is no reliable method to measure objectively the degree
      of intravascular dehydration. Respiratory changes in Inferior Vena Cava (IVC) diameter have
      been shown to predict volume status in adults. Previous research has demonstrated correlation
      between IVC diameter and volume status in children undergoing hemodialysis. Other studies
      have shown that IVC diameter in children can be sonographically measured rapidly and
      accurately by ED physicians. If we can establish that IVC diameter predicts volume status in
      dehydrated children, this tool could assist the ED physician in rapid diagnosis and prompt
      resuscitation without the need to wait for blood or urine tests. In this study we use the
      "dehydrated patient" as a model for hypovolemia, with the idea that the data could ultimately
      be used in the setting of any hypovolemic state. We aim to evaluate whether ultrasound of the
      pediatric IVC can be used to reliably assess volume status.

      Methods: This is a prospective cohort study. Pediatric ED patients ranging in age from 1 to
      41 months were assessed by a Pediatric emergency physician and stratified as either
      clinically euvolemic or hypovolemic. After consent was obtained, one of three Emergency
      Medicine Residents performed trans-abdominal sonographic measurements of the IVC diameter.
      Measurements of the IVC diameter just caudal to the insertion of the hepatic veins were
      obtained in a longitudinal orientation.
    

Detailed description: 
      Ultrasound is considered a routine procedure in the ED. In MMC all ultrasound done by ED
      staff is documented, however patients are not billed for it. All the ultrasound images for
      this study will have to be approved by Dr. Marshall prior to inclusion into the study.

      For the purposes of this study, trans-abdominal ultrasonographic measurements of the Inferior
      Vena Cava (IVC) will be taken in patients suspected of being Dehydrated. The Triage Nurse
      will be the person who would identify acutely dehydrated patient. Once a potential candidate
      is identified The Attending physician in the pediatric ED will be notified. If a sonographer
      is available in the ED at the time and he/she is free/willing to perform the sonogram only
      then will the attending physician will notify and consent the patient.

      The first phase of the study will concentrate on establishing the correlation between
      collapsed IVC and level of dehydration. During the first part of the study, ultrasonography
      will be performed once prior to hydration.

      During this phase we will also perform sonograms on a control group. The Control Group will
      consist of children aged 1 month to 3 years age who we do not suspect of being dehydrated
      based on initial evaluation and presenting complaints.

      During the second phase of the study we will measure the change in IVC diameter with fluid
      resuscitation. During this time, additional ultrasonography will be performed after adequate
      fluid resuscitation.

      Return Visit: For the patient that qualify for a return visit for a weight check, upon
      arrival to the ED, will bypass registration and report to the triage nurse and identify
      themselves, where they will be weighed and then promptly sent home.

      Who needs a return visit? Any patient who is not admitted or does not have a recent weight
      available (at the PMD's office) prior to the onset of the current condition will qualify for
      a return visit. The patients who has a recent weight taken at the PMD's office will be
      requested to sign the hospitals standard consent for transfer of the data via fax from the
      PMD's office.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Any ED patient 1-month to 41 months of age presenting to the ED with a History or vomiting,
        Diarrhea or decreased PO intake
      
Keywords: Children, dehydration, Ultrasound