Use of a hand-held bladder ultrasound scanner in the assessment of dehydration and monitoring response to treatment in a paediatric emergency department.

BACKGROUND: Dehydration is a common concern in paediatric emergency care. Limited tools are available to assess reduced urine production, which is commonly cited as a reliable marker of dehydration.
OBJECTIVES: To evaluate the utility of a hand-held bladder ultrasound scanner in monitoring urine production in children attending the emergency department with suspected dehydration.
METHODS: A prospective pilot study was undertaken on a convenience sample of patients presenting with suspected dehydration. Serial bladder ultrasound scanning was performed to monitor urine output. Dehydration was assessed clinically using the WHO guide to dehydration assessment. Decisions about treatment and admission were made independently of the urine output measurements obtained using the bladder scanner.
RESULTS: 45 children were studied. Using the WHO guide, 33 (73%) had mild dehydration, 8 (18%) had moderate dehydration and 4 (9%) had severe dehydration. There was a significant difference in estimated urine production between those admitted and those discharged (0.9±1.2 ml/kg/h vs 1.8±1.5 ml/kg/h, p=0.01) and between those with mild dehydration versus moderate/severe dehydration (2.3±1.5 ml/kg/h vs 0.6±0.7 ml/kg/h, p=0.0011). Urine output had been significantly reduced in those who had received an intravenous fluid bolus compared with those who had not (0.4±0.46 ml/kg/h vs 1.9±1.6 ml/kg/h, p=0.001).
CONCLUSIONS: The hand-held bladder scanner is a convenient, non-invasive and objective adjunct in the assessment and management of children attending the emergency department with suspected dehydration.