title: Current variability of clinical practice management of pediatric diabetic ketoacidosis in Illinois pediatric emergency departments.
abstract: OBJECTIVE
  This study aimed to investigate the management of pediatric patients with diabetic ketoacidosis (DKA) presenting to emergency departments (EDs) participating in the Illinois Emergency Medical Services for Children (EMSC) Facility Recognition program.
  
  
  METHODS
  In 2010, Illinois EMSC conducted a survey (including case scenarios) and medical record review regarding management of pediatric patients with DKA. Data were submitted by 116 EDs.
  
  
  RESULTS
  Survey response rate was 94%. Only 34% of EDs had a documented DKA guideline/policy; 37% reported that they did not have hospital adult or pediatric endocrinology services. Case scenarios identified a high percentage of respondents given an intravenous (IV) isotonic sodium chloride solution of 10 to 20 mL/kg during the first hour. However 17% to 21% would use an alternative choice such as administering initial IV solution of 0.45 sodium chloride, initiating an insulin drip before fluids, or waiting for more laboratory results before giving fluids or insulin. A total of 532 medical record reviews were submitted. In 87% of records, patients received an initial IV isotonic sodium chloride solution within the first hour. In 74%, patients received IV insulin infusion/drip (0.1 U/kg/h) after the initial fluid bolus. Of the patients, 51% were transferred to another facility; 22% were admitted to an intensive care unit.
  
  
  CONCLUSIONS
  Best ED practice management of pediatric DKA includes establishing a specific guideline/protocol and ensuring access to a pediatric endocrinologist. Both were identified as improvement areas in this project. Illinois EMSC has developed an educational module and provided direct feedback to all participating EDs, to improve their management of pediatric patients with DKA.
authors.affiliation: Lawndale Christian Health Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Barrios
authors.forename: Joseph
authors.initials: J
authors.lastname: Hageman
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lyons
authors.forename: Kathryn
authors.initials: K
authors.lastname: Janies
authors.forename: Daniel
authors.initials: D
authors.lastname: Leonard
authors.forename: Stephen
authors.initials: S
authors.lastname: Duck
authors.forename: Susan
authors.initials: S
authors.lastname: Fuchs
mesh_terms: D000293:Adolescent; D001929:Brain Edema / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D016883:Diabetic Ketoacidosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004704:Endocrinology; D005440:Fluid Therapy / Q000379:methods / Q000706:statistics & numerical data; D019983:Guideline Adherence; D019538:Health Care Surveys; D006753:Hospital Records; D006801:Humans; D007087:Illinois; D007223:Infant; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D012965:Sodium Chloride / Q000627:therapeutic use
chemical_list: D007328:Insulin; D012965:Sodium Chloride