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


METHODS
The subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose >or=250mg/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).


RESULTS
Three risk groups for DKA/NKHS were identified: a high-risk group of patients with glucose >400mg/dl or systolic blood pressure <100mmHg; a low risk group of patients with glucose <or=400mg/dl and normal vital signs (systolic blood pressure >or=100mmHg, pulse <or=90/min, and respiratory rate <or=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.


CONCLUSIONS
Our algorithm may help DKA/NKHS triage and patients with normal vital signs can be initially triaged as low risk for DKA/NKHS.
Tokuda
Yasuharu
Y
Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan. tokuyasu@orange.ocn.ne.jp <tokuyasu@orange.ocn.ne.jp>
Omata
Fumio
F
Tsugawa
Yusuke
Y
Maesato
Kyouko
K
Momotura
Kazuhisa
K
Fujinuma
Atsuko
A
Stein
Gerald H
GH
Cook
E Francis
EF
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001786:Blood Glucose / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014218:Triage; D055986:Vital Signs
D001786:Blood Glucose