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The utility of ketones at triage: a prospective cohort study
  1. Sheena Durnin1,
  2. Jennifer Jones1,
  3. Emer Ryan1,
  4. Ruth Howard1,
  5. Sean Walsh1,
  6. Ian Dawkins2,
  7. Carol Blackburn1,3,
  8. Sinead M O'Donnell1,
  9. Michael J Barrett3,4
  1. 1 Department of Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland
  2. 2 Paediatric Intensive Care Unit, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland
  3. 3 Women and Children’s Health, School of Medicine, University College Dublin, Dublin, Ireland
  4. 4 National Children's Research Centre, Dublin, Ireland
  1. Correspondence to Clinical Associate Professor Michael J Barrett, National Children's Research Centre, Dublin, Ireland; michael.barrett{at}olchc.ie

Abstract

Objective To establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales.

Design, setting and patients Prospective unblinded study from April 2016 to February 2017 in a paediatric emergency department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of moderate or severe dehydration or clinical concern for hypoglycaemia were eligible.

Main outcome measures The primary outcome was to describe the relationship between triage POC ketones to the two Gorelick Scales. Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition.

Results One-hundred and ninety-eight patients were included; median age 1.8 years. The median triage ketones were 4.6 (IQR 2.8–5.6) mmol/L. A weak correlation was identified between triage ketones and the 10-point Gorelick Scale (Spearman’s ρ=0.217, p=0.002), however no correlation between triage ketones and the 4-point Gorelick Scale was identified. Those admitted had median triage ketones of 5.2 (IQR 4–6) mmol/L and repeat ketones of 4.6 (IQR 3.3–5.7) mmol/L compared with 4.2 (IQR 2.4–5.3) mmol/L and 2.9 (IQR 1.6–4.2) mmol/L in those discharged home.

Conclusion No correlation between triage POC ketones and the 4-point Gorelick Scale was established. POC ketones at triage have poor accuracy for predicting hospital admission. The elevated profile of POC ketones in non-diabetic children with acute illness suggests a potential target of tailored treatments for further research.

  • general Paediatrics
  • paediatric Practice
  • accident & emergency
  • biochemistry
  • gastroenterology
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Footnotes

  • Twitter @0shetweeted, @PEM_Dublin

  • Deceased Ruth Howard deceased on 3 March 2018.

  • Contributors SD, CB, SMO, SW and MJB conceived and designed the study. MJB supervised the conduct of the study and data collection. JJ, ER, CB and MJB recruited patients. SD, JJ, RH and ER managed the data. SD, ID and MJB provided statistical advice and aided with data analysis. SD drafted the article, and all authors contributed substantially to its revision. MJB takes responsibility for the paper as a whole.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Ethics (Medical Research) Committee of Children’s Health Ireland at Crumlin, Ireland (GEN/474/16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The study protocol, informed consent forms, data collection proforma and statistical analysis plan will be available immediately after publication to researchers who provide a methodically sound proposal up to 5 years after publication. Proposals should be directed to michael.barrett@olchc.ie. To gain access data requesters need to sign a data access agreement and the data will be emailed to them once the proposal is approved.

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