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{
    "pk": 9605,
    "title": "Optic Nerve Sheath Diameter Measurement During Diabetic Ketoacidosis: A Pilot Study",
    "subtitle": null,
    "abstract": "Introduction: \nOptic nerve sheath diameter (ONSD) measurement accurately detects elevated intracranial pressure and may facilitate early recognition of diabetic ketoacidosis-related cerebral edema (DKA-CE). Our objective was to assess how ONSD measurement varies during T1D-related illness, in order to determine the potential of this tool for discrimination of subclinical DKA-CE.\n \n \n \nMethods: \nWe prospectively enrolled patients aged 7–18 years into three study arms: 1) well-controlled type 1 diabetes; 2) type 1 diabetes with hyperglycemia; 3) DKA. Exclusion criteria included >10 mL/kg of intravenous fluid or insulin prior to transfer, or conditions predisposing to increased intracranial or intraocular pressure. ONSD measurements were obtained within 4h of arrival. One-way ANOVA and multivariable linear regression were used to assess ONSD between groups and association with known DKA-CE risk factors, respectively. Reliability measures were assessed and target enrollment was 36 patients per arm based on sample size calculations.\n \n \n \nResults: \nWe enrolled 108 patients.\n \nNo patients had clinically overt DKA-CE. The between group difference in mean ONSD (mm ± SD) among patients with well-controlled type 1 diabetes (5.2 ± 0.85), T1D with hyperglycemia (5.0 ± 0.91), and DKA (5.2 ± 0.92) was not significant (p=0.79). Mean ONSD was not independently associated with presenting laboratory parameters, known DKA-CE risk factors, or time to ultrasound. There was good agreement between sonographers (88.9% agreement; intraclass correlation coefficient 0.71).\n \n \n \nConclusion:\n ONSD measurements did not vary significantly based on T1D-related illness severity, and thus, may not sufficiently discriminate subclinical DKA-CE.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "pediatrics"
        },
        {
            "word": "Cerebral Edema"
        },
        {
            "word": "Diabetic ketoacidosis"
        },
        {
            "word": "point-of-care ultrasound"
        }
    ],
    "section": "Technology in Emergency Medicine",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/9j2201q2",
    "frozenauthors": [
        {
            "first_name": "Kelly",
            "middle_name": "R.",
            "last_name": "Bergmann, DO, MS",
            "name_suffix": "",
            "institution": "Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Donna",
            "middle_name": "M.",
            "last_name": "Milner, MD",
            "name_suffix": "",
            "institution": "Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Constantinos",
            "middle_name": "",
            "last_name": "Voulgaropoulos, MD",
            "name_suffix": "",
            "institution": "Children's Hospitals and Clinics of Minnesota, McNeely Pediatric Diabetes Center and Endocrinology Clinic, Minneapolis, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Gretchen",
            "middle_name": "J.",
            "last_name": "Cutler, PhD",
            "name_suffix": "",
            "institution": "Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota",
            "department": "None"
        },
        {
            "first_name": "Anupam",
            "middle_name": "B.",
            "last_name": "Kharbanda, MD",
            "name_suffix": "",
            "institution": "Children's Hospitals and Clinics of Minnesota, Department of Pediatric Emergency Medicine, Minneapolis, Minnesota",
            "department": "None"
        }
    ],
    "date_submitted": "2016-02-01T20:17:46Z",
    "date_accepted": "2016-02-01T20:17:46Z",
    "date_published": "2016-07-25T18:14:47Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/9605/galley/5346/download/"
        }
    ]
}