ESPE Abstracts

Introduction: Diabetic ketoacidosis (DKA) is a common medical emergency and is the most common cause of death in children with type 1 diabetes mellitus due its complications. Paediatric residents are usually the first line whom managing paediatric emergencies in Iraqi hospitals. They form the backbone of the provided service. It is important to make sure they are practicing at the highest possible standard to ensure patients’ safety. Therefore, it is crucial to check their knowledge and confidence in managing paediatric endocrine emergencies.

Objectives: this study evaluates the knowledge of Iraqi paediatric residents regarding DKA recognition and management. It also sheds the light on the areas that need further improvement.

Methods: An online survey was conducted. A survey link of the questionnaire using SurveyMonkey was sent to residents from different levels between first to fourth year of training (R1-4) in general paediatrics.

Results: The survey was completed by 47 residents. 60.9% of them completed more than 6 months of paediatric emergency training placement. Only 28.9% of the residents recognized the correct diagnostic criteria of DKA, with R4 trainees accounting for the highest percentage (45.5%). 83.3% of R3 and 81.8% of R4 responders chose 0.9% sodium chloride as a maintenance intravenous fluid without adding potassium chloride to it, 80.4% of residents would start the insulin infusion after 60 minutes from starting the intravenous fluids. 69.6% of residents are not routinely attaching their patients to a cardiac monitor unless the patient is unstable or deteriorating during the DKA management.

Majority of residents (73.9%) recognized that cerebral oedema is a life-threatening complication of DKA but failed in recognizing other life-threatening complications such as hypokalaemia and aspiration pneumonia as these were identified by only 30.4% and 13% of residents, respectively. 66.7% of R1-3 doctors can detect symptoms and signs of cerebral oedema compared to 81.8% of R4 doctors. 69.6% of residents felt confident in treating children presenting with DKA; with the highest average score of confidence came from R3 residents. Saying that, the vast majority of responded paediatric residents (91.3%) think there is a need for more DKA teaching/educational sessions.

Conclusions: Gaps in knowledge of correctly diagnosing DKA and subsequently its management were identified. Lack of a standardized national protocol is a contributing factor. Educational sessions for the residents about DKA management deemed necessary and it was demanded by the residents themselves.