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Point-of-care ultrasound to assess degree of dehydration in children: a systematic review with meta-analysis
  1. Maciej Kołodziej1,
  2. Anita Jalali2,
  3. Jan Łukasik1
  1. 1 Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
  2. 2 Medical University of Warsaw, Warsaw, Poland
  1. Correspondence to Maciej Kołodziej, Department of Paediatrics, Medical University of Warsaw, Warszawa 02-091, Poland; maciek.kolodziej{at}


Background There is no perfect method to assess level of dehydration in children. There are studies with conflicting results, where point-of-care ultrasound (POCUS) measurement of diameter ratio of the inferior vena cava to the aorta (IVC/Ao) was used to predict degree of dehydration.

Objective To systematically review the diagnostic accuracy of POCUS measurement of IVC/Ao ratio in predicting dehydration in children.

Methods MEDLINE, EMBASE and Cochrane databases were searched. The primary outcome was the diagnostic accuracy of IVC/Ao ratio. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2.

Results Eleven studies (2679 patients) were included. The most numerous group (five studies) used percentage weight change as a reference standard; the pooled sensitivity, specificity of POCUS in this group were: 0.7 (95% CI: 0.67 to 0.73), I2: 82%; 0.53 (95% CI: 0.5 to 0.53), I2: 84%. In the remaining studies, different comparator tests were used: Clinical Dehydration Scale (two studies, 0.8 (95% CI: 0.72 to 0.86), I2: 0%; 0.56 (95% CI: 0.48 to 0.65), I2: 0%; clinical judgement (three studies, 0.78 (95% CI: 0.73 to 0.83), I2: 95%; 0.82 (95% CI: 0.77 to 0.86), I2: 93% and one study used the Dehydration: Assessing Kids Accurately score model.

Conclusion This systematic review and meta-analysis showed that POCUS has a moderate sensitivity and specificity for identifying dehydration in children. Its use as a complementary diagnostic tool could be promising but needs to be validated in randomised controlled trials.

PROSPERO registration number CRD42022346166.

  • Paediatrics
  • Paediatric Emergency Medicine

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors MK initially conceptualised this study. MK, JŁ and AJ conducted the study. MK and JŁ analysed the data. MK and JŁ had a primary responsibility for drafting the manuscript. All authors contributed to (and agreed on) the final version.

  • Funding Funded by the Medical University of Warsaw.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.