Vital sign triage to rule out diabetic ketoacidosis and non-ketotic hyperosmolar syndrome in hyperglycemic patients

• Published in: Diabetes Research and Clinical Practice Vol. 87; no. 3; pp. 366 - 371
• Main Authors: Tokuda, Yasuharu, Omata, Fumio, Tsugawa, Yusuke, Maesato, Kyouko, Momotura, Kazuhisa, Fujinuma, Atsuko, Stein, Gerald H., Cook, E. Francis
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.03.2010; Elsevier BV
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Algorithms; Blood Glucose; Blood Glucose - metabolism; Diabetic Ketoacidosis; Diabetic Ketoacidosis - blood; Diabetic Ketoacidosis - diagnosis; Diabetic Ketoacidosis - etiology; Diagnosis, Differential; Endocrinology & Metabolism; Female; Humans; Hyperglycemia; Hyperglycemia - blood; Hyperglycemia - complications; Hyperglycemic Hyperosmolar Nonketotic Coma; Hyperglycemic Hyperosmolar Nonketotic Coma - blood; Hyperglycemic Hyperosmolar Nonketotic Coma - diagnosis; Hyperglycemic Hyperosmolar Nonketotic Coma - etiology; Male; Middle Aged; Non-ketotic hyperosmolar syndrome; Prognosis; Recursive partitioning analysis; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Triage; Vital sign; Vital Signs; Non-ketotic hyperosmolar syndrome; Triage; Recursive partitioning analysis; Vital sign; Diabetic ketoacidosis
• ISSN: 0168-8227; 1872-8227; 1872-8227
• DOI: 10.1016/j.diabres.2009.11.020

To develop a prediction algorithm to rule out diabetic ketoacidosis (DKA) and non-ketotic hyperosmolar syndrome (NKHS) based on vital signs for early triage of patients with diabetes. The subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose ≥250 mg/dl) who presented at an emergency department. Based on a derivation sample ( n = 392, 70% of 544 patients at a hospital in Okinawa), recursive partitioning analysis was used to develop a tree-based algorithm. Validation was conducted using the other 30% of the patients in Okinawa ( n = 152, internal validation) and patients at a hospital in Tokyo ( n = 95, external validation). Three risk groups for DKA/NKHS were identified: a high-risk group of patients with glucose >400 mg/dl or systolic blood pressure <100 mmHg; a low risk group of patients with glucose ≤400 mg/dl and normal vital signs (systolic blood pressure ≥100 mmHg, pulse ≤90/min, and respiratory rate ≤20/min); and an intermediate risk group. The prevalences of DKA/NKHS were 2% (derivation set), 0% (internal validation set), and 0% (external validation set) in the low risk group, respectively. Our algorithm may help DKA/NKHS triage and patients with normal vital signs can be initially triaged as low risk for DKA/NKHS.