Quantifying edema in skin tissue in children after cardiac surgery: the QuEST study

Abstract

Abstract Objectives To investigate the validity of a 19-point clinical edema score (CES) and mid-limb circumferences for quantifying edema. Methods A prospective exploratory study was performed in mechanically ventilated children after cardiac surgery in a tertiary pediatric intensive care unit (PICU). Body weight, a CES, and mid-limb circumferences were performed at baseline and two consecutive 24-h intervals. Results We studied fifty-nine children with a median age of 8.0 days [IQR; 1.0, 14.0]. Body weight and edema measurements were performed at enrolment (baseline) and two subsequent 24-h time points. Between baseline and 24 h, the median change in body weight was −33g [IQR; −146, 106], and between 24 and 48 h, −97g [IQR; −241, −28]. Changes in the CES and leg circumference, but not arm circumference, were significantly associated with small changes in body weight. In a multivariable linear, mixed effects model, accounting for repeated measures within children and baseline values, there was statistically significant evidence that every point increase in CES was associated with an increase of 12.6 g [95%CI; 3.6–21.5] in body weight. Similarly, a 1-cm increase in leg circumference was associated with an increase in body weight of 46.7 g [95%CI; 3.5–89.9]. However, there was no statistically significant association between arm circumference and body weight. Conclusions In children after cardiac surgery, a CES and leg circumference, but not arm circumference, may be a valid measure of fluid accumulation. Larger studies in broader populations of critically ill children are warranted.