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Adherence to pediatric diabetic ketoacidosis guidelines by community emergency departments' providers

Janine E Zee-Cheng1, Emily C Webber2, Samer Abu-Sultaneh3

  • 1Section of Pediatric Critical Care Medicine, Indianapolis, IN, USA.

International Journal of Emergency Medicine
|March 22, 2017
PubMed

Insights

Adherence to pediatric diabetic ketoacidosis (DKA) guidelines in Indiana community emergency departments is low. Many children with DKA do not receive recommended care, highlighting a need for improved adherence to established protocols.

Area of Science:

  • Pediatric Endocrinology
  • Emergency Medicine
  • Clinical Quality Improvement

Background:

  • Diabetic ketoacidosis (DKA) is a frequent emergency department presentation for type 1 diabetes.
  • Community emergency departments often lack immediate access to pediatric-specific DKA guidelines compared to academic centers.

Purpose of the Study:

  • To assess adherence to pediatric DKA guidelines in Indiana community emergency departments.
  • Identify potential gaps in the management of pediatric DKA.

Main Methods:

  • Retrospective chart review of pediatric patients (age ≤18) diagnosed with DKA.
  • Analysis of adherence to key pediatric DKA guideline parameters.

Main Results:

  • Only 37% of pediatric DKA patients were managed according to all six guideline parameters.
  • Hourly blood glucose checks were administered to only 39% of patients.
  • 30% of patients received an intravenous insulin bolus, which is not recommended.

Conclusions:

  • Significant non-adherence to pediatric DKA guidelines persists in Indiana.
  • Further research is required to understand the reasons for non-adherence and develop effective improvement strategies.
Abstract

Keywords:
Clinical guidelinesCommunity emergency departmentsDiabetic ketoacidosisPediatricType 1 diabetes mellitus

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