Vital sign triage to rule out diabetic ketoacidosis and non-ketotic hyperosmolar syndrome in hyperglycemic patients.
Vital sign triage to rule out diabetic ketoacidosis and non-ketotic hyperosmolar syndrome in hyperglycemic patients.
复制标题
生命体征分类以排除高血糖患者的糖尿病酮症酸中毒和非酮症高渗综合征。
DOI：
10.1016/j.diabres.2009.11.020
复制
发表时间：
2010
影响因子：
5.1
通讯作者：
E. Francis Cook
中科院分区：
文献类型：
--
作者：
Y. Tokuda;F. Omata;Y. Tsugawa;K. Maesato;Kazuhisa Momotura;Atsuko Fujinuma;Gerald H. Stein;E. Francis Cook
目的开发一种预测算法，根据生命体征排除糖尿病酮症酸中毒(DKA)和非酮症高渗综合征(NKHS)，用于糖尿病患者的早期分诊。方法研究对象为在急诊科就诊的连续成人糖尿病高血糖患者(血糖≥250 mg/dl)。根据派生样本(冲绳一家医院544名患者中的70%，n=392)，使用递归分区分析来开发基于树的算法。使用另外30%的冲绳患者(n=152，内部验证)和东京一家医院的患者(n=95，外部验证)进行验证。结果确定了DKA/NKHS的三个风险组：高风险组血糖400 mg/dl或收缩压100≤；低风险组血糖400 mg/dl，生命体征正常(收缩压≥100 mm Hg，脉搏≤90次/分，呼吸频率≤20次/分)；以及中危组。DKA/NKHS在低风险组的患病率分别为2%(派生集)、0%(内部验证集)和0%(外部验证集)。结论SOUR算法可以帮助DKA/NKHS分诊，生命体征正常的患者可以被初步分派为低风险患者。
AIMSTo 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.METHODSThe subjects were consecutive adult diabetic patients with hyperglycemia (blood glucose ≥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).RESULTSThree 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 ≤400mg/dl and normal vital signs (systolic blood pressure ≥100mmHg, pulse ≤90/min, and respiratory rate ≤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.CONCLUSIONSOur algorithm may help DKA/NKHS triage and patients with normal vital signs can be initially triaged as low risk for DKA/NKHS.