Objectives Diabetic ketoacidosis (DKA) in paediatrics is a common condition and often the first presentation of type 1 diabetes mellitus in children. The number of citations a study receives can be used as a marker of academic influence, and can help to identify strong and weak areas of research within a particular field. We aimed to identify the 50 most influential studies relating to paediatric DKA by citation number, and analyse their characteristics.

Methods The Web of Science database was used to determine the studies that were most frequently cited. We searched for studies that included ‘Diabetic ketoacidosis’ or ‘DKA’ along with ‘paediatric’ or ‘children’ or ‘child’ or ‘infant’ in the title. Data extracted included publication year, article type and focus, publication journal, institution and country, level of evidence (LOE) and total citation number. Published guidelines were excluded from the LOE rankings. Citation density was also calculated as number of citations per year since publication.

Results Our search returned 410 studies. The top 50 studies were published between 1976 to 2014. The most common study topics were epidemiology and pathophysiology, with many studies relating to cerebral oedema (n=19). The mean number of citations was 74.7 (standard deviation 60.3, range 28–375). These were published in 21 journals, led by Pediatric Diabetes (n=9). They originated from 9 different countries, with institutions from the United States of America publishing the majority (n=30), and the University of California, Davis publishing the most studies (n=7). One RCT was identified, 39 non-randomised clinics studies were included. The remainder included reviews, basic science studies and guidelines. 10 studies were classified as LOE 1, and 11 studies as LOE 4.

Conclusions The 50 top cited studies on paediatric DKA relate mostly to epidemiology and pathophysiology. Cerebral oedema in paediatric DKA patients has received increased attention by researchers and institutions. LOE was low, with only one RCT identified. Though these studies are the most influential in the field, perhaps the evidence base for this field would benefit from further high quality trials.