High-fidelity simulation-based validation of applicability of the new Italian society for pediatric endocrinology and diabetes (ISPED) recommendations for pediatric diabetic ketoacidosis management.

AIM: To use high-fidelity simulation to validate the clinical applicability and safety of the recently updated Italian Society for Pediatric Endocrinology and Diabetes (ISPED) recommendations for the management of diabetic ketoacidosis (DKA).

METHODS

Expert pediatric diabetologists participated in a full-day simulation session. Teams of four managed three advanced scenarios on a pediatric manikin: severe DKA, DKA with cerebral edema, and DKA with acute kidney injury (AKI). During the scenarios, teams utilized the new guidelines as a paper protocol, a digital application, and an AI chatbot. Each session was followed by a structured debriefing to analyze decisions, protocol adherence, and user experience, with feedback collected via questionnaires and discussion.

RESULTS

The simulation confirmed the overall robustness and clinical validity of the new guidelines. Participants appreciated the increased detail on managing complications like cerebral edema and AKI. A key learning point emerged regarding uncertainty in the initial choice of fluids (normal saline vs. Ringer’s lactate). A quantitative analysis of user experience revealed a statistically significant preference for the paper protocol, which outperformed digital versions on key usability metrics, including efficiency and dependability (p < 0.001). The AI chatbot, despite being rated as highly novel, was perceived as impractical and inefficient.

CONCLUSION

High-fidelity simulation is an effective methodology for prospectively validating and refining clinical practice guidelines in a controlled environment before official release. We confirm the validity of the new ISPED recommendations while identifying key areas for targeted training and the need for the user-centered design of digital support tools.