Department of Paediatric Emergency Medicine, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland.
Paediatric Intensive Care Unit, Children's Health Ireland at Crumlin, Crumlin, Dublin, Ireland.
Arch Dis Child. 2020 Dec;105(12):1157-1161. doi: 10.1136/archdischild-2019-318425. Epub 2020 Jul 3.
To establish the relationship between serum point-of-care (POC) ketones at triage and moderate-to-severe dehydration based on the validated Gorelick Scales.
DESIGN, SETTING AND PATIENTS: Prospective unblinded study from April 2016 to February 2017 in a paediatric emergency department. Patients aged 1 month to 5 years, with vomiting and/or diarrhoea and/or decreased intake with signs of moderate or severe dehydration or clinical concern for hypoglycaemia were eligible.
The primary outcome was to describe the relationship between triage POC ketones to the two Gorelick Scales. Secondary outcomes were to examine the response of ketone levels to fluid/glucose administration and patient disposition.
One-hundred and ninety-eight patients were included; median age 1.8 years. The median triage ketones were 4.6 (IQR 2.8-5.6) mmol/L. A weak correlation was identified between triage ketones and the 10-point Gorelick Scale (Spearman's ρ=0.217, p0.002), however no correlation between triage ketones and the 4-point Gorelick Scale was identified. Those admitted had median triage ketones of 5.2 (IQR 4-6) mmol/L and repeat ketones of 4.6 (IQR 3.3-5.7) mmol/L compared with 4.2 (IQR 2.4-5.3) mmol/L and 2.9 (IQR 1.6-4.2) mmol/L in those discharged home.
No correlation between triage POC ketones and the 4-point Gorelick Scale was established. POC ketones at triage have poor accuracy for predicting hospital admission. The elevated profile of POC ketones in non-diabetic children with acute illness suggests a potential target of tailored treatments for further research.
根据经过验证的戈尔利克量表，建立分诊时血清即时检测（POC）酮体与中重度脱水之间的关系。
设计、地点和患者：2016 年 4 月至 2017 年 2 月在儿科急诊进行的前瞻性非盲研究。纳入年龄在 1 个月至 5 岁、有呕吐和/或腹泻和/或摄入减少且有中重度脱水体征或临床低血糖怀疑的患者。
主要结局是描述分诊时 POC 酮体与戈尔利克量表两种量表的关系。次要结局是检查酮体水平对液体/葡萄糖给药和患者处置的反应。
共纳入 198 例患者，中位年龄 1.8 岁。分诊时 POC 酮体中位数为 4.6（IQR 2.8-5.6）mmol/L。在分诊时酮体与 10 分戈尔利克量表之间发现了微弱的相关性（Spearman's ρ=0.217，p0.002），但在分诊时酮体与 4 分戈尔利克量表之间未发现相关性。入院患者的分诊时 POC 酮体中位数为 5.2（IQR 4-6）mmol/L，重复检测的酮体中位数为 4.6（IQR 3.3-5.7）mmol/L，而出院患者的分诊时 POC 酮体中位数为 4.2（IQR 2.4-5.3）mmol/L，重复检测的酮体中位数为 2.9（IQR 1.6-4.2）mmol/L。
未建立分诊时 POC 酮体与 4 分戈尔利克量表之间的相关性。POC 酮体在分诊时对预测住院无准确性。急性疾病中非糖尿病儿童的 POC 酮体升高提示可能是针对进一步研究的靶向治疗的潜在目标。
