Implementation and Outcome of a Protocol-Based Treatment for Diabetic Ketoacidosis in a Tertiary Care Pediatric Emergency Department.

IF 1.2 4区 医学 Q3 EMERGENCY MEDICINE
Gulser Esen Besli, Merve Nur Hepokur, Sibel Ergin Sahin, Asan Onder, Metin Yildiz, Irem Bulut, Hamdi Cihan Emeksiz
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引用次数: 0

Abstract

Background: The standardization of clinical practice in emergency treatment of diabetic ketoacidosis (DKA) is a prerequisite for improving patient care. For this purpose, a standardized DKA protocol incorporating a two-bag system has been implemented since January 2020 in our center.

Objectives: To assess the impact of the development and utilization of the standard treatment pathway for DKA on patient outcomes.

Methods: This retrospective cohort study involved patients diagnosed with DKA and admitted to the pediatric emergency department (PED). The entire period of the study was from January 2017 to September 2022. Patients with DKA managed before and after implementation of the protocol were compared in terms of clinical outcomes.

Results: Out of 145 patients, 77 (53%) patients were in the pre-protocol group, 68 (47%) were in the protocol group. Age, sex, and severity of DKA were similar between the groups. Implementation of the protocol resulted in shorter resolution time of acidosis and ketosis (p = 0.007, p < 0.001, respectively), higher correction rates of bicarbonate and blood ketones (p = 0.003, p < 0.001, respectively), shorter duration of IV insulin treatment (p = 0.008), more appropriate potassium dosage administrating to IV fluids (p < 0.001), lower incidence of hypokalemia, hypophosphatemia, and hypoglycemia (p = 0.008, p = 0.002, p = 0.036, respectively), and smaller number of IV bags use (p < 0.001).

Conclusion: Implementation of a protocol-based pathway for DKA involving a two-bag system provided earlier correction of ketoacidosis, decreased the risk of complications, and reduced resource utilization in the PED.

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来源期刊
Journal of Emergency Medicine
Journal of Emergency Medicine 医学-急救医学
CiteScore
2.40
自引率
6.70%
发文量
339
审稿时长
2-4 weeks
期刊介绍: The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine
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