• Yasuharu Tokuda, Fumio Omata, Yusuke Tsugawa, Kyouko Maesato, Kazuhisa Momotura, Atsuko Fujinuma, Gerald H Stein, and E Francis Cook.
• Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan. tokuyasu@orange.ocn.ne.jp <tokuyasu@orange.ocn.ne.jp>
• Diabetes Res. Clin. Pract. 2010 Mar 1; 87 (3): 366-71.

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 >or=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 or=100mmHg, pulse ConclusionsOur algorithm may help DKA/NKHS triage and patients with normal vital signs can be initially triaged as low risk for DKA/NKHS.

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