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Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick.
Diabetes Care 2011; 34(4):852-4DC

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 β-hydroxybutyrate (β-OHB) analysis with the urine dipstick.

RESEARCH DESIGN AND METHODS

Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-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, β-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 β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-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.

Authors+Show Affiliations

Department of Clinical Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. sanjay.arora@usc.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21307381

Citation

Arora, Sanjay, et al. "Diagnostic Accuracy of Point-of-care Testing for Diabetic Ketoacidosis at Emergency-department Triage: {beta}-hydroxybutyrate Versus the Urine Dipstick." Diabetes Care, vol. 34, no. 4, 2011, pp. 852-4.
Arora S, Henderson SO, Long T, et al. Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick. Diabetes Care. 2011;34(4):852-4.
Arora, S., Henderson, S. O., Long, T., & Menchine, M. (2011). Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick. Diabetes Care, 34(4), pp. 852-4. doi:10.2337/dc10-1844.
Arora S, et al. Diagnostic Accuracy of Point-of-care Testing for Diabetic Ketoacidosis at Emergency-department Triage: {beta}-hydroxybutyrate Versus the Urine Dipstick. Diabetes Care. 2011;34(4):852-4. PubMed PMID: 21307381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnostic accuracy of point-of-care testing for diabetic ketoacidosis at emergency-department triage: {beta}-hydroxybutyrate versus the urine dipstick. AU - Arora,Sanjay, AU - Henderson,Sean O, AU - Long,Theodore, AU - Menchine,Michael, Y1 - 2011/02/09/ PY - 2011/2/11/entrez PY - 2011/2/11/pubmed PY - 2011/7/16/medline SP - 852 EP - 4 JF - Diabetes care JO - Diabetes Care VL - 34 IS - 4 N2 - 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 β-hydroxybutyrate (β-OHB) analysis with the urine dipstick. RESEARCH DESIGN AND METHODS: Emergency-department patients with blood glucose ≥250 mg/dL had urine dipstick, chemistry panel, venous blood gas, and capillary β-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, β-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 β-OHB and the urine dipstick are equally sensitive for detecting DKA (98.1%). However, β-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. SN - 1935-5548 UR - https://www.unboundmedicine.com/medline/citation/21307381/Diagnostic_accuracy_of_point_of_care_testing_for_diabetic_ketoacidosis_at_emergency_department_triage:_{beta}_hydroxybutyrate_versus_the_urine_dipstick_ L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=21307381 DB - PRIME DP - Unbound Medicine ER -