Dehydration is a common concern in children presenting to pediatric emergency departments and other acute care settings. Ultrasound of the inferior vena cava (IVC) may be a fast, noninvasive tool to gauge volume status, but its utility remains unclear.

The purpose of a new study published in Pediatric Emergency Care was to determine the interobserver agreement of IVC collapse and collapse duration, then correlate IVC collapse with the outcome of intravenous (IV) versus oral (PO) rehydration.

This was a prospective study that enrolled 112 patients aged 0-21 years, with emesis requiring ondansetron or with diarrhea requiring IV hydration. Clinical operators interpreted ultrasound examinations in real time to determine whether the IVC was collapsed. Cohens kappa(κ) was calculated for reviewer-reviewer and reviewer-operator agreement. Primary outcomes were PO versus IV rehydration and admitted versus discharged.

Overall, 102 had complete data for analysis – 51% females, the mean age being 7.2 years. Among these 29 patients received IV hydration. The reviewer-operator agreement for IVC collapse was κ = 0.57 and inter-reviewer agreement was κ = 0.93. Whereas, the inter-reviewer agreement for collapse duration was κ = 0.66. All patients with non-collapsed IVCs tolerated PO hydration. The likelihood of receiving IV hydration could be correlated with the duration of IVC collapse.

In inference, it was stated that based on a novel dynamic measure of IVC collapse duration, children with increasing duration of IVC collapse correlated positively with the need for IV rehydration. Noncollapsing IVCs on US were associated with successful PO rehydration without the need for IV fluids or emergency department revisits.

Source: Pediatric Emergency Care. 2020 Jun 11. doi: 10.1097/PEC.0000000000002150.