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3 results on '"Juvenal Musavuli"'

1. Prediction of severe disease in children with diarrhea in a resource-limited setting.

Author

Adam C Levine, Richard M Munyaneza, Justin Glavis-Bloom, Vanessa Redditt, Hannah C Cockrell, Bantu Kalimba, Valentin Kabemba, Juvenal Musavuli, Mathias Gakwerere, Jean Paul de Charles Umurungi, Sachita P Shah, and Peter C Drobac

Subjects
Medicine, Science
Abstract

To investigate the accuracy of three clinical scales for predicting severe disease (severe dehydration or death) in children with diarrhea in a resource-limited setting.Participants included 178 children admitted to three Rwandan hospitals with diarrhea. A local physician or nurse assessed each child on arrival using the World Health Organization (WHO) severe dehydration scale and the Centers for Disease Control (CDC) scale. Children were weighed on arrival and daily until they achieved a stable weight, with a 10% increase between admission weight and stable weight considered severe dehydration. The Clinical Dehydration Scale was then constructed post-hoc using the data collected for the other two scales. Receiver Operator Characteristic (ROC) curves were constructed for each scale compared to the composite outcome of severe dehydration or death.The WHO severe dehydration scale, CDC scale, and Clinical Dehydration Scale had areas under the ROC curves (AUCs) of 0.72 (95% CI 0.60, 0.85), 0.73 (95% CI 0.62, 0.84), and 0.80 (95% CI 0.71, 0.89), respectively, in the full cohort. Only the Clinical Dehydration Scale was a significant predictor of severe disease when used in infants, with an AUC of 0.77 (95% CI 0.61, 0.93), and when used by nurses, with an AUC of 0.78 (95% CI 0.63, 0.93).While all three scales were moderate predictors of severe disease in children with diarrhea, scale accuracy varied based on provider training and age of the child. Future research should focus on developing or validating clinical tools that can be used accurately by nurses and other less-skilled providers to assess all children with diarrhea in resource-limited settings.

Published
2013
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2. Ultrasound Assessment of Severe Dehydration in Children With Diarrhea and Vomiting

Author

Sachita Shah, Vicki E. Noble, Richard B. Mark Munyaneza, Irenee Umulisa, Adam C. Levine, Jean Marie Dushimiyimana, Juvenal Musavuli, Sara Stulac, Protogene Ngabitsinze, Henry Epino, and Katrina Stegmann

Subjects
medicine.medical_specialty, Receiver operating characteristic, business.industry, Weight change, General Medicine, Inferior vena cava, Surgery, Diarrhea, medicine.vein, Predictive value of tests, cardiovascular system, Emergency Medicine, medicine, Vomiting, medicine.symptom, business, Prospective cohort study, Cohort study
Abstract

Objectives: The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale). Methods: The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard. Results: Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale. Conclusions: Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management. ACADEMIC EMERGENCY MEDICINE 2010; 17:1035–1041 © 2010 by the Society for Academic Emergency Medicine

Published
2010
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3. Ultrasound assessment of severe dehydration in children with diarrhea and vomiting

Author

Adam C, Levine, Sachita P, Shah, Irenee, Umulisa, Richard B Mark, Munyaneza, Jean Marie, Dushimiyimana, Katrina, Stegmann, Juvenal, Musavuli, Protogene, Ngabitsinze, Sara, Stulac, Henry M, Epino, and Vicki E, Noble

Subjects
Diarrhea, Male, Vomiting, Vena Cava, Inferior, Risk Assessment, Severity of Illness Index, Cohort Studies, Predictive Value of Tests, Confidence Intervals, Humans, Prospective Studies, Child, Infusions, Intravenous, Developing Countries, Aorta, Dehydration, Hemodynamics, Rwanda, Infant, Ultrasonography, Doppler, Prognosis, Treatment Outcome, ROC Curve, Child, Preschool, Fluid Therapy, Female
Abstract

The objective of this study was to determine the test characteristics for two different ultrasound (US) measures of severe dehydration in children (aorta to inferior vena cava [IVC] ratio and IVC inspiratory collapse) and one clinical measure of severe dehydration (the World Health Organization [WHO] dehydration scale).The authors enrolled a prospective cohort of children presenting with diarrhea and/or vomiting to three rural Rwandan hospitals. Children were assessed clinically using the WHO scale and then underwent US of the IVC by a second clinician. All children were weighed on admission and then fluid-resuscitated according to standard hospital protocols. A percent weight change between admission and discharge of greater than 10% was considered the criterion standard for severe dehydration. Receiver operating characteristic (ROC) curves were created for each of the three tests of severe dehydration compared to the criterion standard.Children ranged in age from 1 month to 10 years; 29% of the children had severe dehydration according to the criterion standard. Of the three different measures of dehydration tested, only US assessment of the aorta/IVC ratio had an area under the ROC curve statistically different from the reference line. At its best cut-point, the aorta/IVC ratio had a sensitivity of 93% and specificity of 59%, compared with 93% and 35% for IVC inspiratory collapse and 73% and 43% for the WHO scale.Ultrasound of the aorta/IVC ratio can be used to identify severe dehydration in children presenting with acute diarrhea and may be helpful in guiding clinical management.

Published
2010

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