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Review: capillary refill time, abnormal skin turgor, and abnormal respiratory pattern help to detect dehydration in children

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Q In children, what is the accuracy of signs, symptoms, and laboratory tests for detecting dehydration?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ GP/FP/Emergency Medicine ★★★★★★☆ Emergency Medicine (Specialist) ★★★★★★☆ Paediatrics ★★★★★★☆


Embedded ImageData sources:

Medline (January 1966 to April 2003), the Cochrane Library, reference lists, and experts in the field.

Embedded ImageStudy selection and assessment:

studies in any language that compared signs, symptoms, and laboratory values with a recognised gold standard for diagnosing dehydration in children (age 0–18 y). Study quality was ranked from highest quality (level 1   =   independent, blind comparisons of test with a valid gold standard) to lowest quality (level 5   =   non-independent comparison of test with an uncertain standard of validity, which may incorporate the test result into the gold standard).

Embedded ImageOutcomes:

sensitivity, specificity, and positive and negative likelihood ratios (LRs).


13 studies (n  =  1246) met the selection criteria (4 intermediate quality and 9 low quality). Clinically useful signs for detecting 5% dehydration were capillary refill time, abnormal skin turgor, and abnormal respiratory pattern (table). …

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  • For correspondence: Dr D A DeWalt, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.

  • Source of funding: Robert Wood Johnson Clinical Scholars Program.

  • Reproduced with permission from