Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic.
Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic.
复制标题
在 COVID-19 大流行高峰期间，更多地使用高渗疗法治疗糖尿病酮症酸中毒儿科疑似临床明显脑损伤。
DOI：
10.1155/2023/5123197
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发表时间：
2023
影响因子：
3.4
通讯作者：
Wolfsdorf,Joseph
中科院分区：
文献类型：
--
作者：
Azova,Svetlana;Liu,Enju;Wolfsdorf,Joseph
在新冠肺炎大流行高峰期间，儿童糖尿病酮症酸中毒(DKA)的发病率增加。这项研究的目的是调查在此期间，与紧接大流行之前的三年相比，疑似临床明显脑损伤(CABI)并发DKA的高渗透压治疗率是否也有所增加，并比较大流行前疑似CABI患者、大流行高峰期疑似CABI患者以及大流行期间DKA但没有疑似CABI的患者的特征。通过对两个数据库的严格搜索，确定了在疫情高峰期(2017年3月11日至2020年3月10日)和大流行高峰期(2020年3月11日至2021年3月10日)年龄为18岁的≤18 患者。使用预先定义的标准诊断可疑的CABI。生化、临床和社会人口学数据是从对电子病历的全面审查中收集的。与流行前期相比，在大流行期间接受高渗治疗的DKA患者的比例显著更高(P= 0.014)；然而，这仅在新诊断的糖尿病患者中显著。两组疑似冠脉梗死组均较非冠脉梗死组有更严重的酸中毒、更低的格拉斯哥昏迷量表评分和更长的住院时间(P<； 0.001)。在大流行期间，疑似CABI患者的血尿素氮浓度显著高于非疑似CABI患者，这表明他们脱水更严重。在大流行前和大流行期间，疑似CABI患者的临床、生化和社会人口学特征无法区分。总之，在新冠肺炎大流行高峰期，对疑似冠心病脑梗塞患者进行高渗治疗更为常见，这可能是由于发病延迟所致，这凸显了需要提高认识和及早识别糖尿病和DKA的体征和症状，特别是在未来高度传染性感染激增期间。
The incidence of pediatric diabetic ketoacidosis (DKA) increased during the peak of the COVID‐19 pandemic. The objective of this study was to investigate whether rates of hyperosmolar therapy administration for suspected clinically apparent brain injury (CABI) complicating DKA also increased during this period as compared to the three years immediately preceding the pandemic and to compare the characteristics of patients with suspected CABI before the pandemic, patients with suspected CABI during the peak of the pandemic, and those with DKA but without suspected CABI during the pandemic. Patients aged ≤18 years presenting with DKA before (March 11, 2017–March 10, 2020) and during the peak of the pandemic (March 11, 2020–March 10, 2021) were identified through a rigorous search of two databases. Predefined criteria were used to diagnose suspected CABI. Biochemical, clinical, and sociodemographic data were collected from a comprehensive review of the electronic medical record. The proportion of patients with DKA who received hyperosmolar therapy was significantly higher (P= 0.014) during the pandemic compared to the prepandemic period; however, this was only significant among patients with newly diagnosed diabetes. Both groups with suspected CABI had more severe acidosis, lower Glasgow Coma Scale scores, and longer hospital admissions (P< 0.001 for all) than cases without suspected CABI. During the pandemic, the blood urea nitrogen concentration was significantly higher in patients with suspected CABI than those without suspected CABI, suggesting they were more severely dehydrated. The clinical, biochemical, and sociodemographic characteristics of patients with suspected CABI were indistinguishable before and during the pandemic. In conclusion, administration of hyperosmolar therapy for suspected CABI was more common during the peak of the COVID‐19 pandemic, possibly a result of delayed presentation, highlighting the need for increased awareness and early recognition of the signs and symptoms of diabetes and DKA, especially during future surges of highly transmissible infections.