Care of Children with Diabetic Ketoacidosis in Hospital Emergency Departments

dc.creatorMou, Margaret
dc.creatorPickard, Brenna
dc.creatorHsieh, Susan
dc.creatorThornton, Paul
dc.creatorWilson, Don
dc.description.abstractBackground: Although preventable, diabetic ketoacidosis (DKA) remains a frequent and life-threatening complication of diabetes mellitus. Emergency Departments (ED) are the initial point of treatment for most children with DKA, which emphasizes the critical need for EDs to tailor therapy for their pediatric population. Understanding the evaluation, treatment, and disposition of such patients are critical to improving care and outcomes. Purpose: To conduct a survey of pediatric ED providers to better understand approaches to treating children with DKA. Subjects and Methods: An anonymous electronic survey was distributed to pediatric ED physicians in 6 pediatric emergency departments located in major metropolitan areas. Each of the EDs was part of a pediatric hospital that provides undergraduate and graduate medical education. Data and Conclusions: The majority of emergency department physicians correctly identified published criteria for diagnosis of DKA in children. While 89% either strongly agreed or agreed that children with DKA have ketonuria, only 43% strongly agreed or agreed that children with DKA had a BOBH >3. Reasons for admitting a child with DKA to the hospital included altered mental status, persistent vomiting, and lack of adult supervision. In the past 6 months, of all children treated in the ED with DKA approximately 70% were thought to be autoimmune (i.e. Type 1). The majority of children (91%) who presented to the ED with DKA were admitted; very few were discharged home (6.2%) or admitted to a short stay unit (2.8%). Aside from the pediatric ICU, use of a continuous IV insulin drip was not used either during emergency transport or while a child was admitted to the inpatient pediatric floor. However, 73.2% of respondents stated they used continuous IV insulin drip in the ED to treat DKA. Except for glucose and electrolytes, point of care testing was not available for hemoglobin or BOHB acid testing. Barriers to treating children with DKA in the ED included lack of familiarity with DKA treatment guidelines and lack of adequate inpatient facilities. Suggestions for enhancing knowledge of DKA treatment in the ED included education programs, educational materials, evidence based guidelines for treatment of DKA and a hospital or department sponsored DKA quality improvement initiative.
dc.titleCare of Children with Diabetic Ketoacidosis in Hospital Emergency Departments