Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.
Diabetes Res Clin Pract. 2010 Mar;87(3):366-71. doi: 10.1016/j.diabres.2009.11.020. Epub 2009 Dec 22.
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 >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).
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.
Our algorithm may help DKA/NKHS triage and patients with normal vital signs can be initially triaged as low risk for DKA/NKHS.
开发一种基于生命体征的预测算法，用于排除糖尿病酮症酸中毒（DKA）和非酮症高渗综合征（NKHS），以便对糖尿病患者进行早期分诊。
研究对象为连续就诊于急诊科的高血糖（血糖>250mg/dl）成年糖尿病患者。基于推导样本（n=392，来自冲绳某医院的 544 例患者中的 70%），采用递归分区分析建立基于树的算法。在冲绳的另外 30%的患者（n=152，内部验证）和东京某医院的患者（n=95，外部验证）中进行验证。
确定了 3 个 DKA/NKHS 风险组：高风险组患者血糖>400mg/dl 或收缩压<100mmHg；低风险组患者血糖≤400mg/dl 且生命体征正常（收缩压≥100mmHg，脉搏<90/min，呼吸频率<20/min）；中间风险组。低风险组 DKA/NKHS 的患病率分别为 2%（推导组）、0%（内部验证组）和 0%（外部验证组）。
我们的算法有助于 DKA/NKHS 分诊，且生命体征正常的患者可初步归类为 DKA/NKHS 低风险。
