10 J DIARRHOEAL DIS RES Mar 1999 Zodpey et al. J DIARRHOEAL DIS RES 1999 Mar;17(1):10-16 © 1999 ICDDR,B: Centre for Health and Population Research 0253-8768/99 $ 1.00+0.10 A Prediction Model for Moderate or Severe Dehydration in Children with Diarrhoea Sanjay P Zodpey 1 , Sanjay G Deshpande 2 , Suresh N Ughade 3 , Shyam W Kulkarni 4 , Sunanda N Shrikhande 5 , and Archana V Hinge 6 1 Associate Professor, Clinical Epidemiology Unit and Department of Preventive and Social Medicine; 2 Lecturer, Department of Preventive and Social Medicine; 3 Lecturer, Clinical Epidemiology Unit and Department of Preventive and Social Medicine; 4 Dean and Sponsor, Clinical Epidemiology Unit; 5 Lecturer, Department of Microbiology; and 6 Lecturer, Department of Medicine, Government Medical College, Nagpur 440 003, Maharashtra State, India. ABSTRACT A hospital-based unmatched case-control study (387 cases and 387 controls) was carried out at the Government Medical College Hospital, Nagpur, India, to devise and validate a risk-scoring system for predicting the development of moderate or severe dehydration in children, aged less than five years, with acute watery diarrhoea. On unconditional multiple logistic regression, 12 risk factors--infancy, minority religion, undernutrition, not washing hands by mother before preparation of food, frequency of stools >8/day, frequency of vomiting >2/day, measles in previous 6 months, withdrawal of breast-feeding/other feedings, withdrawal of fluids during diarrhoea, not giving oral rehydration solutions (ORS), home available fluids and both during diarrhoea- -were significant. Based on regression coefficients, these factors were ascribed statistical weights of 5, 5, 4, 4, 22, 9, 11, 13, 5, 5, 5, and 7 respectively. The receiver-operating characteristic curve suggested a total score of 48 to be the best cut-off for predicting the development of moderate or severe dehydration. At this cut-off, the sensitivity, specificity, positive predictive value, Cohen's kappa, and overall predictive accuracy were 0.81, 0.81, 0.81, 0.61, and 0.86 respectively. If substantiated by further validation, this system can be used for predicting the development of dehydration at the earlier stage, thereby reducing the mortality associated with life-threatening dehydration. Key words: Diarrhoea, Infantile; Diarrhoea, Acute; Dehydration; Case-control studies; Risk factors; Epidemiology Correspondence and reprint requests should be addressed to: Dr. Sanjay P. Zodpey Plot 305, Hanuman Nagar Nagpur 440009, Maharashtra State, India INTRODUCTION Diarrhoeal diseases are still one of the leading causes of morbidity and mortality in children in developing countries (1), and are responsible for approximately one- third of the 15 million deaths, each year, of children aged less than five years (2). Although the majority of episodes are self-limited, a small proportion quickly lead to dehydration and death (3,4). Most deaths due to diarrhoea are attributed to development of moderate or severe dehydration (5,6). Little is relatively known about what puts a child at risk of developing life-threatening dehydration (7). A number of hypothesized risk factors have been shown to be associated with the development of moderate or severe dehydration (2,7). Their relative contribution to the development of moderate or severe dehydration reportedly varies from study to study and from population to population. Moreover, the combined effect of these risk factors can help in better prediction of development of moderate or severe dehydration in