Abstract:
OBJECTIVE:Diabetic ketoacidosis (DKA) is a common emergency department presentation of both new-onset and established diabetes mellitus (DM). β-Hydroxybutyrate (BOHB) provides a direct measure of the pathophysiologic derangement in DKA as compared with the nonspecific measurements of blood pH and bicarbonate. Our objective was to characterize the relationship between BOHB and DKA. METHODS:This is a cross-sectional retrospective study of pediatric patients with DM presenting to an urban pediatric emergency department between January 1, 2016, and September 30, 2018. Analyses were performed on each patient's initial, simultaneous BOHB and pH. Diagnostic test characteristics of BOHB were calculated, and logistic regression was performed to investigate the effects of age and other key clinical factors. RESULTS:Among 594 patients with DM, with median age of 12.3 years (interquartile range, 8.7-15.9 years), 176 (29.6%) presented with DKA. The inclusion of age, transfer status, and new-onset in the statistical model did not improve the prediction of DKA beyond BOHB alone. β-Hydroxybutyrate demonstrated strong discrimination for DKA, with an area under the curve of 0.95 (95% confidence interval, 0.93-0.97). A BOHB value of 5.3 mmol/L predicted DKA with optimal accuracy (90.6% of patients were correctly classified). The sensitivity, specificity, and positive and negative predictive values of this cut point were 76.7% (95% confidence interval, 69.8%-82.7%), 96.4% (94.2%-98.0%), 90.0% (84.0%-94.3%), and 90.8% (87.7%-93.3%), respectively. CONCLUSIONS:β-Hydroxybutyrate accurately predicts DKA in children and adolescents. More importantly, because plasma BOHB is the ideal biochemical marker of DKA, BOHB may provide a more optimal definition of DKA for management decisions and treatment targets.
journal_name
Pediatr Emerg Carejournal_title
Pediatric emergency careauthors
Tremblay ES,Millington K,Monuteaux MC,Bachur RG,Wolfsdorf JIdoi
10.1097/PEC.0000000000002035subject
Has Abstractpub_date
2020-02-01 00:00:00eissn
0749-5161issn
1535-1815pub_type
杂志文章abstract:OBJECTIVES:Radiographic survey of the entire aerodigestive tract (nares to anus) is common practice in children presenting to the emergency department following coin ingestion. The purpose of our study was to determine the optimal protocol for radiographic survey post-coin ingestion. We hypothesized that for children p...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001688
更新日期:2018-11-19 00:00:00
abstract::We report an unusual case of deep vein thrombosis following minor trauma in an adolescent who presented with a swollen, tender, lower extremity. Work-up consisted of a venogram which demonstrated occlusion of the deep venous system in the proximal leg. The patient was hospitalized for intravenous heparin followed by o...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-198906000-00008
更新日期:1989-06-01 00:00:00
abstract::We report a case involving accidental ingestion of a marble that was detected by point-of-care ultrasonography of the abdomen with the patient in the upright and slightly forward tilting position, which we term the "bowing position." Using this position for abdominal ultrasonography may be more useful than the usual s...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001125
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVES:This study aimed to survey pediatric emergency medicine (PEM) providers on their management of 2 hypothetical acute concussion scenarios. We hypothesized that most providers would recommend a management strategy based on cognitive and physical rest. METHODS:Fifty-nine percent (46/78) of PEM providers that w...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001727
更新日期:2019-01-21 00:00:00
abstract::Unlike adults, small children and infants do not require stretchers or ambulances for transport from a prehospital scene to the emergency department (ED). This study was designed to determine the importance of this difference in patient transport needs. A Macintosh Classic computer was programmed to compare the time t...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199202000-00003
更新日期:1992-02-01 00:00:00
abstract::Meckel diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract and the most common cause of gastrointestinal bleeding in children. Although it usually follows the rule of 2's, exceptions to this rule are reported in the literature. Often asymptomatic, MD is commonly an incidental finding ...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001388
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVES:The National Pediatric Readiness Project of the Emergency Medical Services for Children surveyed emergency departments in the United States in 2013 for readiness to provide emergency care to children. However, that survey did not query for many elements considered essential to Advanced Trauma Life Support (A...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002144
更新日期:2020-06-09 00:00:00
abstract::Corn starch powder is widely used for routine infant skin care as a substitute for talcum powder, as it is believed to have fewer respiratory hazards. We describe a one-month-old infant who presented to an emergency department with respiratory failure and a severe pneumonitis from aspiration of corn starch powder. The...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-199604000-00011
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVES:To ascertain the incidence, determinants, and outcome of sepsis workup in febrile infants aged 0-90 days with respiratory syncytial virus (RSV) infection. DESIGN:Retrospective chart review. RESULTS:191 infants with RSV, 21.5% younger than 28 days, were identified; 101 (52.9%) were febrile and 90 were afebr...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000092576.40174.28
更新日期:2003-10-01 00:00:00
abstract:OBJECTIVES:High patient volumes have a deleterious effect on care in the pediatric emergency department (PED). Our study assessed the motivation for PED visits that could have been assessed by a primary care physician. METHODS:We identified a convenience sample of patients presenting to the SickKids Hospital PED in Ju...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001598
更新日期:2018-09-01 00:00:00
abstract::Although brachial plexus injury occurring during multitrauma is frequent in adults, it is rarely observed in childhood. The most common cause of pediatric traumatic brachial palsy is motor vehicle accidents followed by pedestrian struck. Generally, phrenic nerve palsy accompanying brachial plexus trauma is observed in...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31829ec20b
更新日期:2013-08-01 00:00:00
abstract::Pediatric rapid sequence intubation is a skill of great importance to emergency medicine physicians. Developing a systematic strategy for approaching an emergent airway aids in the proper handling of this event. This paper is a review of the current recommendations for pediatric rapid sequence intubation including cur...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000125667.58561.62
更新日期:2004-05-01 00:00:00
abstract::Foreign body aspirations in children are relatively uncommon occurrences, but they can be a serious events, causing respiratory distress, atelectasis, chronic pulmonary infections, or death. Safety pins are not commonly aspirated objects and account for less than 3% of all foreign bodies found in the tracheobronchial ...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/00006565-199712000-00011
更新日期:1997-12-01 00:00:00
abstract:INTRODUCTION:Resuscitation skills decay as early as 4 months after course acquisition. Gaps in research remain regarding ideal educational modalities, timing, and frequency of curricula required to optimize skills retention. Our objective was to evaluate the impact on retention of resuscitation skills 8 months after th...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001849
更新日期:2019-07-11 00:00:00
abstract:PURPOSE:This study aimed to compare clinical manifestations, physical examination findings, laboratory, and radiographic dates in pediatric patients with different pathological diagnoses of acute scrotum as well as to accurately establish the true incidence of various pathological diagnoses of acute scrotum. METHODS:T...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e318213144e
更新日期:2011-04-01 00:00:00
abstract::Antidotes are playing an increasing role in therapy for pediatric poisonings. Although initial response to all pediatric poisonings begins with basic stabilization, knowledge of specific antidotes, their mechanisms of action, safety profile in pediatrics, and dosing regimens can be life-saving for pediatric victims of...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/01.pec.0000245174.21041.bc
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:This study aimed to compare efficacy of enema versus polyethylene glycol (PEG) 3350 for pediatric fecal impaction treatment. METHODS:We conducted a prospective, randomized comparison of treatments of fecal impaction in children in a pediatric emergency department (ED). Treatment arms were a single milk and m...
journal_title:Pediatric emergency care
pub_type: 杂志文章,随机对照试验
doi:10.1097/PEC.0b013e3182442c0a
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to evaluate, in children undergoing procedural sedation for magnetic resonance imaging (MRI) scans, whether lower doses of propofol than previously published permitted a high rate of successful MRI completion, whether lower dosages result in a more rapid recovery, and whether age or b...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000002289
更新日期:2020-11-11 00:00:00
abstract:OBJECTIVE:The objective of this study was to compare the sensitivity and specificity of 2- and 4-film x-ray series when interpreted by pediatric emergency medicine physicians in the diagnosis of skull fracture in children. METHODS:A noninferiority crossover study was performed. The skull radiographs of the 50 most rec...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3182a9f7c1
更新日期:2013-11-01 00:00:00
abstract::Constipation is a common cause of pediatric abdominal pain seen in pediatric emergency departments (EDs). We present the case of an 11-year-old boy with a 4-month history of chronic constipation and abdominal pain who presented to the children's ED. He was found to have a large abdominal mass that was determined to be...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000166
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:To describe the clinical course and determine the minimal observation period required following isopropanol ingestion in children. METHODS:The emergency department records of children less than 6 years of age with isopropanol ingestion who presented between June 1992 and December 1998 were identified. Demogr...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/00006565-200008000-00005
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVES:Lollapalooza (LP) is an annual 3-day outdoor music festival in Chicago. Underage drinking and drug use are believed to be common, but the burden on emergency departments (EDs) has not been documented. We assessed the burden on health care resources associated with this music festival. METHODS:We performed a...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000001072
更新日期:2019-06-01 00:00:00
abstract::Posttraumatic pseudoaneurysms are extremely rare in pediatric populations. In many cases, pseudoaneurysms may be confused with abscesses, epidermoid cysts, arteriovenous fistula, foreign objects, and ganglion cysts, as well as tumors. They are associated with distinguishing findings of "pulsatile mass, a palpable thri...
journal_title:Pediatric emergency care
pub_type: 杂志文章,评审
doi:10.1097/PEC.0000000000001236
更新日期:2019-12-01 00:00:00
abstract::Clinical signs of hypophosphatemia, even when severe, are rare in diabetic ketoacidosis despite their high frequency in this condition. This article presents a patient with rhabdomyolysis due to severe hypophosphatemia, where the level of serum phosphorus was observed to be as low as 0.42 mg/dL on the 16th hour of ket...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31821dc68a
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVES:The Accreditation Council for Graduate Medical Education requires pediatric residency training programs to provide exposure to the prehospital management and transport of patients. The authors hypothesized that compared with a similar study a decade prior, current pediatric residency training programs have r...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e31823ed4ab
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVES:This study aimed to assess the association between the appearance of intussusception in children and medication intake in the immediately preceding period (2-15 days). METHODS:A case-crossover design was used. We selected cases of children admitted with a diagnosis of intussusception (International Classifi...
journal_title:Pediatric emergency care
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/PEC.0000000000000397
更新日期:2015-04-01 00:00:00
abstract::Rhabdomyosarcoma is the most common soft tissue tumor of childhood, frequently presenting in the head and neck, genitourinary tract, or extremities. We present a case of rhabdomyosarcoma in which an 18-year-old woman presented with abrupt onset unilateral hearing loss, tinnitus, dysarthria, dysphagia, and a new painle...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181b0a482
更新日期:2009-08-01 00:00:00
abstract::Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal shunt and is seen more commonly in the pediatric population. The diagnosis of an abdominal cerebrospinal fluid pseudocyst is typically made by ultrasonography, which demonstrates a simple or loculated fluid collection in the a...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0000000000000826
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:To determine the success rate and complications of using the external jugular (EJ) vein for central venous access in pediatric patients. METHODS:Prospective cohort study of children who underwent attempts at EJ vein central venous access while receiving care in an 11-bed pediatric intensive care unit at an u...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/PEC.0b013e3181ea71ca
更新日期:2010-08-01 00:00:00
abstract::We present a case of a 4-month-old girl referred to the emergency department with a provisional diagnosis of acute life-threatening event with a recent episode of heart block and a history of long-lasting fever. Soon after admission, the child suddenly deteriorated rapidly; she became pulseless with complete heart blo...
journal_title:Pediatric emergency care
pub_type: 杂志文章
doi:10.1097/01.pec.0000195757.74328.68
更新日期:2006-01-01 00:00:00