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The utility of ketones at triage: a prospective cohort study


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

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 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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