Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

Clark, Matthew G.; Dalabih, Abdallah

doi:10.4274/jcrpe.1434

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Despite the establishment of guidelines for treatment of pediatric DKA in 2006, a practice gap still exists. This has been demonstrated previously by Barrios [ 15 ] and Clark [ 16 ] by a survey of providers caring for patients with DKA, but has not previously been demonstrated by reviewing all patient records of referring facility.…”

Section: Discussionmentioning

confidence: 62%

“…Prior studies have evaluated variability of care via surveys administered to physicians and providers at referring facilities [15, 16], but there has been little exploration into actual adherence of referring providers to pediatric DKA guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…Pediatric patients with DKA often present first to community emergency departments (EDs) and are then referred to tertiary care centers for ongoing management of their DKA. Prior studies have evaluated variability of care via surveys administered to physicians and providers at referring facilities [ 15 , 16 ], but there has been little exploration into actual adherence of referring providers to pediatric DKA guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers

Zee-Cheng¹,

Webber

Abu‐Sultaneh³

2017

Int J Emerg Med

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BackgroundDiabetic ketoacidosis (DKA) is a common presentation of type I diabetes mellitus to the emergency departments. Most children with DKA are initially managed in community emergency departments where providers may not have easy access to educational resources or pediatric-specific guidelines and protocols that are readily available at pediatric academic medical centers. The aim of this study is to evaluate adherence of community emergency departments in the state of Indiana to the pediatric DKA guidelines.MethodsWe performed a retrospective chart review of patients, age 18 years of age or under, admitted to the pediatric intensive care unit with a diagnosis of DKA.ResultsA total of 100 patients were included in the analysis. Thirty-seven percent of patients with DKA were managed according to all six guideline parameters. Only 39% of patients received the recommended hourly blood glucose checks. Thirty percent of patients received intravenous insulin bolus, which is not recommended.ConclusionsNon-adherence to pediatric DKA guidelines still exists in the state of Indiana. Further, larger studies are needed to reveal the etiology of non-adherence to pediatric DKA guidelines and strategies to improve that adherence.

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Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers

Zee-Cheng¹,

Webber

Abu‐Sultaneh³

2017

Int J Emerg Med

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“…Several institutions identified paediatric DKA as a high priority topic as it has detrimental effects on the health of affected children if not diagnosed early and managed appropriately. They recommended establishing and using a specific CPG for DKA for improvement of health care quality and safety …”

Section: Discussionmentioning

confidence: 99%

Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital

Amer

Nemri

Osman

et al. 2018

Evaluation Clinical Practice

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The paediatric doctors, and nurses have a great perception and satisfaction and positive attitude towards CPGs in general, towards the paediatric diabetic ketoacidosis CPG in particular, which in turn had a positive impact on the acceptability and implementation of the CPGs. These findings could help in sustaining a safe and high-quality health care environment through implementation of evidence-based CPGs.

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“…There is some variability in protocols for DKA management, but the basic principles are similar in the various protocols available in the literature [40,51,64,65]. Protocols enabling standardization of treatment are of great value to the treating team involved; however, clinical judgment should always be practiced.…”

Section: Standard Protocols For Dka Managementmentioning

confidence: 99%

Diabetic Ketoacidosis in the Pediatric Population with Type 1 Diabetes

Cohen¹,

Shilo²,

Zuckerman‐Levin³

et al. 2015

Major Topics in Type 1 Diabetes

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Diabetic ketoacidosis DK" is a leading cause of morbidity and mortality in patients with type diabetes T DM . Individuals familiar with this complication of diabetes should be able to identify the earliest signs and symptoms and act promptly to prevent further deterioration. However, even in patients with established diabetes, the rates of DK" are considerable. This chapter discusses in detail the various aspects of DK" in the pediatric population with T DM. The prevalence and regional effects on the prevalence of DK" as well as the specific risk factors, whether disease, patient, or physician related, are reviewed. Patients with DK" experience a condition of starvation despite the abundance of metabolic substrate i.e., glucose the pathophysiological mechanisms responsible for the development of DK" are outlined. Next, a detailed discussion of the clinical aspects of DK" is provided. This includes the clinical findings at presentation, the approach to treatment, and potential complications. Prevention is the best method for reducing rates of DK". Somewhat different factors apply in patients with new-onset diabetes when compared with those with established diabetes and these are reviewed.

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Variability of DKA Management Among Pediatric Emergency Room and Critical Care Providers: A Call for More Evidence-Based and Cost-Effective Care?

Cited by 8 publications

References 5 publications

Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers

Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments’ providers

Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital

Diabetic Ketoacidosis in the Pediatric Population with Type 1 Diabetes

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