Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA

Kristy Wilkinson; Sinha Sanghamitra; Priya Nair; Javier Sanchez; Shashikanth Ambati

doi:10.1515/jpem-2022-0245

Article

Utility of head CT scan in treatment decisions for suspected cerebral edema in children with DKA

Kristy Wilkinson , Sinha Sanghamitra , Priya Nair , Javier Sanchez and Shashikanth Ambati

Published/Copyright: September 29, 2022

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 35 Issue 10

Abstract

Objectives

Cerebral edema (CE) remains one of the most feared complications of diabetic ketoacidosis (DKA) with severe morbidity and mortality. The use of computerized tomography (CT) scan in the setting of suspected cerebral edema in DKA has been minimally studied. The objective of our study was to evaluate the utility of CT scans in children with suspected cerebral edema, and secondarily to analyze the various patient characteristics of those with and without cerebral edema.

Methods

We performed a retrospective chart review of all the children with DKA secondary to T1DM admitted to our tertiary PICU in order to obtain demographic data, laboratory results, and their treatment course. Differences between the groups of suspected CE and no suspected CE were compared using linear and logistic regression for continuous and binary variables respectively.

Results

We identified 251 patients with DKA, 12 of which had suspected CE; 67% (8/12) of those patients received head CT and 87.5% (7/8) of them were read as normal. On the other hand, 33% (4/12) did not receive CT scan of head, and yet three of the four patients were treated for CE.

Conclusions

In our cohort of patients, CT results did not influence CE treatment or lack thereof; most patients with suspected CE were treated with or without head CT findings of CE, indicating that imaging has very little utility in our cohort of patients. In some cases, the use of head CT delayed the onset of treatment for CE.

Keywords: cerebral edema; DKA; head CT

Corresponding author: Kristy Wilkinson, MD, Department of Pediatrics, Albany Medical Center, 39 Columbia Street, Apartment 510, Albany, NY 12207, USA, Phone: +1 518 859 6150, E-mail: Wilkink1@amc.edu

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Dr. Wilkinson collected data, carried out data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. Ms Nair collected data, carried out data analysis, and helped draft the initial manuscript, Dr. Sanghamitra helped design the study and collect preliminary data. Drs. Ambati and Sanchez conceptualized and designed the study, coordinated and supervised data collection, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was waived for this study by our institution IRB.
Ethical approval: The local Institutional Review Board deemed the study exempt from review. Albany Medical Center Institutional Review Board IRB #5044.

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Received: 2022-05-03

Accepted: 2022-08-17

Published Online: 2022-09-29

Published in Print: 2022-10-26

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Articles in the same Issue

https://doi.org/10.1515/jpem-2022-0245

Keywords for this article

cerebral edema; DKA; head CT