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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 5 of 5 Research Studies DisplayedMichelson KA, Bachur RG, Grubenhoff JA
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
This study’s objective was to determine 90-day complication rates and hospital utilization after a missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis (DKA), or sepsis. The authors evaluated patients under 21 years of age visiting five pediatric emergency departments (EDs) with a study condition. Case patients included had a preceding ED visit within 7 days of diagnosis and underwent case review to confirm a missed diagnosis. The authors compared complication rates and utilization between case and control patients after adjusting for age, sex, and insurance. They analyzed 29,398 children with appendicitis, 5366 with DKA, and 3622 with sepsis, of whom 429, 33, and 46, respectively, had a missed diagnosis. Patients with a missed appendicitis or DKA diagnosis had more hospital days and readmissions, but there were no significant differences for those with sepsis. Those with missed appendicitis were more likely to have abdominal abscess drainage or perforated appendicitis. Those with missed DKA were more likely to have cerebral edema, mechanical ventilation, or death. Those with missed sepsis were less likely to have mechanical ventilation.
AHRQ-funded; HS026503.
Citation: Michelson KA, Bachur RG, Grubenhoff JA .
Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals.
J Emerg Med 2023 Jul; 65(1):e9-e18. doi: 10.1016/j.jemermed.2023.04.006..
Keywords: Children/Adolescents, Sepsis, Diabetes, Diagnostic Safety and Quality
Tremblay ES, Millington K, Monuteaux MC
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Diabetic ketoacidosis (DKA) is a common emergency department presentation of both new-onset and established diabetes mellitus (DM). β-Hydroxybutyrate (BOHB) provides a direct measure of the pathophysiologic derangement in DKA as compared with the nonspecific measurements of blood pH and bicarbonate. The objective of this study was to characterize the relationship between BOHB and DKA. The investigators concluded that β-Hydroxybutyrate accurately predicted DKA in children and adolescents. More importantly, because plasma BOHB is the ideal biochemical marker of DKA, BOHB may provide a more optimal definition of DKA for management decisions and treatment targets.
AHRQ-funded; HS000063.
Citation: Tremblay ES, Millington K, Monuteaux MC .
Plasma β-Hydroxybutyrate for the diagnosis of diabetic ketoacidosis in the emergency department.
Pediatr Emerg Care 2021 Dec;37(12):e1345-e50. doi: 10.1097/pec.0000000000002035..
Keywords: Children/Adolescents, Emergency Department, Diabetes, Diagnostic Safety and Quality
Letourneau LR, Carmody D, Wroblewski K
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
In this study, the largest of its kind, diabetic ketoacidosis (DKA) was more frequent than in other early-onset U.S. studies or other cohorts of patients with neonatal diabetes. The authors argue that continuing to educate pediatric providers about the many ways that infants can present with diabetes may help to diagnose cases more efficiently and ultimately decrease the frequency of DKA at diagnosis.
AHRQ-funded; HS023007.
Citation: Letourneau LR, Carmody D, Wroblewski K .
Diabetes presentation in infancy: high risk of diabetic ketoacidosis.
Diabetes Care 2017 Oct;40(10):e147-e48. doi: 10.2337/dc17-1145.
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Keywords: Diabetes, Diagnostic Safety and Quality, Newborns/Infants, Children/Adolescents
Carmody D, Lindauer KL, Naylor RN
Adolescent non-adherence reveals a genetic cause for diabetes.
Glucokinase related maturity-onset diabetes of the young (GCK-MODY) is frequently unrecognized or misdiagnosed as Type 1 or Type 2 diabetes, resulting in unnecessary pharmacologic therapy. The authors recommend considering a genetic cause when evaluating every person with new-onset hyperglycaemia or those with atypical diabetes. Testing costs for the most common MODY causing genes may be offset by savings made in therapeutic costs. They suggest that it is important that all clinicians supervising diabetes care recognize the cardinal features that distinguish GCK-MODY from other forms of diabetes.
AHRQ-funded; HS023007.
Citation: Carmody D, Lindauer KL, Naylor RN .
Adolescent non-adherence reveals a genetic cause for diabetes.
Diabet Med 2015 Jun;32(6):e20-3. doi: 10.1111/dme.12669.
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Keywords: Children/Adolescents, Diabetes, Diagnostic Safety and Quality, Genetics, Medication
Lawrence JM, Black MH, Zhang JL
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
The researchers explored the utility of different algorithms for diabetes case identification by using electronic health records. They found that case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications.
AHRQ-funded; HS019859.
Citation: Lawrence JM, Black MH, Zhang JL .
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
Am J Epidemiol 2014 Jan;179(1):27-38. doi: 10.1093/aje/kwt230..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality