Gilhotra Yuri, Porter Paul
Department of Paediatric Emergency Medicine, Mater Children's Hospital, Raymond Tce, South Brisbane, QLD 4101, Australia.
J Paediatr Child Health. 2007 Oct;43(10):677-80. doi: 10.1111/j.1440-1754.2007.01186.x.
To determine if nasal capnography can be used as a screening tool to predict diabetic ketoacidosis (DKA) in children with Type 1 diabetes mellitus (T1DM) presenting to the emergency department.
Cross-sectional, prospective, observational study of children with T1DM who presented to the Emergency Department of Princess Margaret Hospital for Children, Western Australia, over a 12-month period from June 2003 to June 2004. Information on demographic data and T1DM was recorded. Nasal capnography, venous blood gases and urinary analysis were performed on patients. Data were analysed using chi(2) tests and receiver operating characteristic curve analysis. Sensitivities and specificities were calculated at different end-tidal carbon dioxide (ETCO(2)) levels to predict presence of DKA.
Fifty-eight patients aged 1-18 years (mean 10.7, SD 4.7) were analysed. Thirty-three (57%) were male and 30 (52%) presented with new onset of T1DM. Of the 58 cases, 15 (26%) had DKA, and 11 of these were new T1DM patients. No patients with an ETCO(2) > 30 mmHg had DKA (sensitivity 1.0, specificity 0.86). Six patients with an ETCO(2) < 30 mmHg did not have DKA.
Nasal capnography in conjunction with clinical assessment is predictive of DKA. Further research into this area with larger numbers could help validate ETCO(2) as a screening tool for DKA in the emergency department.
确定鼻二氧化碳监测能否作为一种筛查工具，用于预测就诊于急诊科的1型糖尿病（T1DM）儿童发生糖尿病酮症酸中毒（DKA）的情况。
对2003年6月至2004年6月期间就诊于西澳大利亚州玛格丽特公主儿童医院急诊科的T1DM儿童进行横断面、前瞻性观察研究。记录人口统计学数据和T1DM相关信息。对患者进行鼻二氧化碳监测、静脉血气分析和尿液分析。采用卡方检验和受试者工作特征曲线分析对数据进行分析。计算不同呼气末二氧化碳（ETCO₂）水平下预测DKA存在的敏感性和特异性。
分析了58例年龄在1至18岁（平均10.7岁，标准差4.7）的患者。33例（57%）为男性，30例（52%）为新诊断的T1DM患者。58例患者中，15例（26%）发生DKA，其中11例为新诊断的T1DM患者。ETCO₂>30 mmHg的患者中无DKA发生（敏感性1.0，特异性0.86）。6例ETCO₂<30 mmHg的患者未发生DKA。
鼻二氧化碳监测结合临床评估可预测DKA。对该领域进行更大规模的进一步研究可能有助于验证ETCO₂作为急诊科DKA筛查工具的有效性。
