{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T04:04:19Z","timestamp":1746417859027,"version":"3.40.4"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>This study aims to identify key characteristics of hyperglycemic emergencies in pediatric patients and those at risk for acute neurologic dysfunction during transport.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a retrospective chart review of pediatric patients during interfacility transport by Ornge, Ontario's critical care transport service, from January 1, 2009, to December 31, 2019. Data were extracted from electronic patient care records and included demographic, clinical, and transport-specific variables. Two multiple logistic regression models were utilized to analyze associations between predictor variables and neurologic dysfunction (GCS, &lt;14).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of the 399 patients included, 24% (n = 95) had a GCS score of &lt;14. Patients with a GCS score of &lt;14 were more acidotic compared with those with a GCS score of \u226514 (median pH, 6.9 [IQR, 6.8\u20137.1] vs median, pH 7.0 [IQR, 1.0\u20137.2]; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Higher median corrected sodium for glucose values were observed in patients with a GCS score of &lt;14 compared to those with a GCS score of \u226514 (145.7 mmol\/L [IQR, 140.6\u2013149.9 mmol\/L] vs 141.7 mmol\/L [IQR, 138.3\u2013146.4 mmol\/L]; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Multiple logistic regression identified younger age (aOR, 0.91; 95% CI, 0.84\u20130.98; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01), severe acidosis (pH &lt;7.10; aOR, 3.56; 95% CI, 1.33\u201311.62; <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02), and higher creatinine (aOR, 1.01; 95% CI, 1.01\u20131.02; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) as risk factors for acute neurologic dysfunction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Our findings reveal associations between acute neurologic dysfunction, younger age, severe acidosis, and elevated corrected sodium for glucose values in pediatric hyperglycemic emergencies during transport. Education and adherence to guidelines are recommended to improve outcomes in this population.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003286","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T15:08:50Z","timestamp":1730300930000},"page":"889-894","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Investigating the Risk Factors Associated With Acute Neurologic Dysfunction in Pediatric Hyperglycemic Emergencies on Transport"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1183-5914","authenticated-orcid":false,"given":"Grant","family":"Scollay","sequence":"first","affiliation":[{"name":"Ornge, Mississauga, Ontario"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zach","family":"Cantor","sequence":"additional","affiliation":[{"name":"Regional Paramedic Program for Eastern Ontario, Ottawa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas D.","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell","family":"MacDonald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice","family":"McGahern","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepti","family":"Reddy","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Webster","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute, Ottawa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuad","family":"Alnaji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jcjd.2021.08.006","article-title":"Increasing incidence of type 1 and type 2 diabetes among Canadian children","volume":"46","year":"2022","journal-title":"Can J Diabetes"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1111\/pedi.13406","article-title":"ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state","volume":"23","year":"2022","journal-title":"Pediatr Diabetes"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.paed.2017.01.002","article-title":"Hyperglycaemic hyperosmolar state (HHS) in children: a practical guide to management","volume":"27","year":"2017","journal-title":"Paediatr Child Health"},{"issue":"Suppl 27","key":"bib4-20250504","first-page":"155","article-title":"ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state","volume":"19","year":"2018","journal-title":"Pediatr Diabetes"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jpeds.2010.09.048","article-title":"Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment","volume":"158","year":"2011","journal-title":"J Pediatr"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/jpc.12980","article-title":"Hyperglycaemic hyperosmolar syndrome in children: patient characteristics, diagnostic delays and associated complications","volume":"52","year":"2016","journal-title":"J Paediatr Child Health"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1056\/NEJM200101253440404","article-title":"Risk factors for cerebral edema in children with diabetic ketoacidosis. 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