{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T13:02:31Z","timestamp":1790254951704,"version":"4.1.0"},"reference-count":18,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T00:00:00Z","timestamp":1767484800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Emerg Medicine Australasia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To (i) assess variation in self\u2010reported screening, monitoring and treatment of elevated ketone levels in non\u2010diabetic children and (ii) establish future research priorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Voluntary electronic survey of staff at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network\u2010affiliated hospitals. Respondents provided information on self\u2010reported practice, beliefs about screening, monitoring, and treating elevated blood ketone levels, and identified future research priorities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four hundred twenty\u2010three nurses and 397 doctors from 28 sites across Australia and NZ contributed responses. Nurses were more likely than doctors to screen (90% vs. 75%) and monitor (66% vs. 37%) ketone levels. Greater than 24\u2009h of vomiting or poor oral intake triggered respondents to check ketone levels (83% and 75% respectively). The definition of \u2018elevated\u2019 ketones varied considerably, with nurses' median 1 (IQR 0.7\u20132) mmol\/L and doctors' median 2 (IQR 1\u20132) mmol\/L. Similarly, \u2018severely elevated\u2019 ketones varied considerably, with nurses' median 3 (IQR 2\u20134) mmol\/L and doctors' median 4 (IQR 3\u20135) mmol\/L. 25% of respondents changed route of fluid administration in response to a severely elevated level, though only half of respondents provided a higher\u2010glucose fluid. Sixty\u2010seven percent of respondents supported further prospective observational research on the role of ketone screening and targeted therapies in children aged 6\u2009months\u20136\u2009years who fail an oral fluid trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nurses and doctors in Australia and NZ regularly screen for high ketone levels in non\u2010diabetic children in ED, with significant differences in interpretation and management of \u2018elevated\u2019 levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1742-6723.70196","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T03:55:15Z","timestamp":1767585315000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Paediatric Ketone Measurement and Intervention in Non\u2010Diabetic Patients in Australasian Emergency Departments: A\n                    <scp>PREDICT<\/scp>\n                    Clinician Survey"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1139-1882","authenticated-orcid":false,"given":"Shannon E.","family":"Trenwith","sequence":"first","affiliation":[{"name":"Emergency Department The Royal Children's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Millar","sequence":"additional","affiliation":[{"name":"Department of Critical Care University of Melbourne  Melbourne Australia"},{"name":"Austin Hospital  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2594-1643","authenticated-orcid":false,"given":"Simon S.","family":"Craig","sequence":"additional","affiliation":[{"name":"Paediatric Emergency Department Monash Medical Centre  Melbourne Victoria Australia"},{"name":"Emergency Research Group, Clinical Sciences, Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"Department of Paediatrics, School of Clinical Sciences at Monash Health Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"issue":"12","key":"e_1_2_10_2_1","first-page":"49","article-title":"Accelerated Starvation of Childhood in the Paediatric Emergency Department","volume":"2","author":"Sandholm K.","year":"2021","journal-title":"Acta Scientific Clinical Case Reports"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1742-6723.13276"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0736-4679(03)00100-8"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0195759"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-6723.2009.01154.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-023-02203-7"},{"key":"e_1_2_10_8_1","unstructured":"Starship Child Health \u201cGastroenteritis\u2014Clinical Practice Guideline [Internet] \u201d2025 https:\/\/starship.org.nz\/guidelines\/gastroenteritis\/."},{"key":"e_1_2_10_9_1","unstructured":"The Royal Children's Hospital Melbourne Australia \u201cClinical Practice Guideline on Gastroenteritis [Internet] \u201d2025 https:\/\/www.rch.org.au\/clinicalguide\/guideline_index\/gastroenteritis\/."},{"key":"e_1_2_10_10_1","unstructured":"Govt WA Child and Adolescent Health Service 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