Knowledge and Confidence of Iraqi Pediatric Residents in Management of Diabetic Ketoacidosis in Children

Abstract

Background: Diabetic ketoacidosis (DKA) is a leading cause of mortality in children with type
1 diabetes mellitus. Pediatric residents in Iraqi hospitals are usually the front liners in managing
pediatric emergencies. Therefore, it is important to make sure they are practicing at the highest
possible standards to ensure patients’ safety. Objectives: this study evaluates the knowledge of
Iraqi pediatric residents regarding DKA recognition and management and sheds the light on the
areas that need further improvement. Methods: An online survey was conducted. A survey link to
an online questionnaire using Survey Monkey was sent to residents at different levels between first
and fourth year of training (R1-R4) in general pediatrics. Results: About 60.9% of respondents
spent more than 6 months in pediatric emergency training. The majority of residents had treated
more than 10 children presented with DKA, with the highest percentage (81.8 %) found among
R4s residents. Only 27.8% of residents recognized the diagnostic criteria of DKA. Three quarters
of the participants could correctly calculate IV fluid infusion rate for maintenance by accounting
for the deficits and subtracting the boluses before calculating the corrections over 48 hours. 68.3%
of respondents would not routinely attach DKA patients to a cardiac monitor unless the patient’s
condition is unstable. 69.6% of survey respondents feel confident in treating children with DKA.
Most participants (91.3%) think that there is a need for more DKA training/education sessions.
Conclusions: Most of the respondents have a reasonable level of knowledge on how to manage
DKA in children in Iraqi children’s hospitals. Some gaps in knowledge were identified and need
to be highlighted in near future. Educational sessions for the residents about DKA management in
children are deemed necessary.