Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick.
Diabetes Care
; 34(4): 852-4, 2011 Apr.
Article
em En
| MEDLINE
| ID: mdl-21307381
ABSTRACT
OBJECTIVE:
In the emergency department, hyperglycemic patients are screened for diabetic ketoacidosis (DKA) via a urine dipstick. In this prospective study, we compared the test characteristics of point-of-care ß-hydroxybutyrate (ß-OHB) analysis with the urine dipstick. RESEARCH DESIGN ANDMETHODS:
Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary ß-OHB measurements. DKA was diagnosed according to American Diabetes Association criteria.RESULTS:
Of 516 hyperglycemic subjects, 54 had DKA. The urine dipstick had a sensitivity of 98.1% (95% CI 90.1-100), a specificity of 35.1% (30.7-39.6), a positive predictive value of 15% (11.5-19.2), and a negative predictive value of 99.4% (96.6-100) for DKA. Using the manufacturer-suggested cutoff of >1.5 mmol/L, ß-OHB had a sensitivity of 98.1% (90.1-100), a specificity of 78.6% (74.5-82.2), a positive predictive value of 34.9% (27.3-43), and a negative predictive value of 99.7% (98.5-100) for DKA.CONCLUSIONS:
Point-of-care ß-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, ß-OHB is more specific (78.6 vs. 35.1%), offering the potential to significantly reduce unnecessary DKA work-ups among hyperglycemic patients in the emergency department.
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Base de dados:
MEDLINE
Assunto principal:
Triagem
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Cetoacidose Diabética
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Sistemas Automatizados de Assistência Junto ao Leito
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Ácido 3-Hidroxibutírico
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Serviço Hospitalar de Emergência
Idioma:
En
Ano de publicação:
2011
Tipo de documento:
Article