Archives de pediatrie : organe officiel de la Societe francaise de pediatrie · 2026
Point-of-care capillary blood ketone testing to predict the need for intravenous or nasogastric tube rehydration in children with acute gastroenteritis.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Laurent Thomas, Binet Aurélien, Manca Barayre Florian
Аннотация
BACKGROUND: Acute gastroenteritis (AGE) is a common childhood infection that causes vomiting and diarrhea due to gastrointestinal inflammation. While clinical scoring systems exist to assess dehydration severity, predicting the most suitable rehydration method remains challenging. Studies have suggested a correlation between blood ketone levels and clinical dehydration in children with AGE.
OBJECTIVE: This study aimed to determine a threshold value for capillary blood ketone levels to guide the selection of appropriate rehydration methods in children with mild to moderate AGE.
METHODS AND SETTINGS: This observational, retrospective, single-center study analyzed data from 540 children aged 3 months to 10 years presenting with AGE symptoms at a pediatric emergency department between September 2023 and August 2024. Clinical parameters, biological markers, and rehydration methods were collected. Statistical analysis included ROC curves to assess the predictive value of capillary blood ketone levels for intravenous (IV) or nasogastric tube rehydration.
RESULTS: The median age was 2 years, and 52% of the children were girls. Of the 405 children with measured blood ketone levels, 186 (35%) required IV or nasogastric tube rehydration. Median capillary blood ketone levels were significantly higher in children requiring IV/nasogastric rehydration (3.45 mmol/L, IQR 3.5) compared to those managed without or with oral rehydration (1.2 mmol/L, IQR 2.1)(p < 0.001). ROC curve AUC was 0.75 (95% CI: 0.70-0.80). A threshold value of 2.5 mmol/L demonstrated 62% sensitivity, 79% specificity, 68% positive predictive value, and 74% negative predictive value.
CONCLUSION: The need for IV or nasogastric tube rehydration in children with AGE can be determined with moderate accuracy using capillary blood ketone measurement. A point-of-care blood ketone measurement with a threshold of 2.5 mmol/L could be an additional objective, rapid, and cost-effective tool that helps healthcare providers make treatment decisions and improve patient referrals in both primary and emergency settings.
OBJECTIVE: This study aimed to determine a threshold value for capillary blood ketone levels to guide the selection of appropriate rehydration methods in children with mild to moderate AGE.
METHODS AND SETTINGS: This observational, retrospective, single-center study analyzed data from 540 children aged 3 months to 10 years presenting with AGE symptoms at a pediatric emergency department between September 2023 and August 2024. Clinical parameters, biological markers, and rehydration methods were collected. Statistical analysis included ROC curves to assess the predictive value of capillary blood ketone levels for intravenous (IV) or nasogastric tube rehydration.
RESULTS: The median age was 2 years, and 52% of the children were girls. Of the 405 children with measured blood ketone levels, 186 (35%) required IV or nasogastric tube rehydration. Median capillary blood ketone levels were significantly higher in children requiring IV/nasogastric rehydration (3.45 mmol/L, IQR 3.5) compared to those managed without or with oral rehydration (1.2 mmol/L, IQR 2.1)(p < 0.001). ROC curve AUC was 0.75 (95% CI: 0.70-0.80). A threshold value of 2.5 mmol/L demonstrated 62% sensitivity, 79% specificity, 68% positive predictive value, and 74% negative predictive value.
CONCLUSION: The need for IV or nasogastric tube rehydration in children with AGE can be determined with moderate accuracy using capillary blood ketone measurement. A point-of-care blood ketone measurement with a threshold of 2.5 mmol/L could be an additional objective, rapid, and cost-effective tool that helps healthcare providers make treatment decisions and improve patient referrals in both primary and emergency settings.