RT Journal Article
SR Electronic
T1 The utility of ketones at triage: a prospective cohort study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 1157
OP 1161
DO 10.1136/archdischild-2019-318425
VO 105
IS 12
A1 Durnin, Sheena
A1 Jones, Jennifer
A1 Ryan, Emer
A1 Howard, Ruth
A1 Walsh, Sean
A1 Dawkins, Ian
A1 Blackburn, Carol
A1 O'Donnell, Sinead M
A1 Barrett, Michael J
YR 2020
UL http://adc.bmj.com/content/105/12/1157.abstract
AB 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.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.