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Table 1 Characteristics of included studies

From: What is the utility of blood beta-hydroxybutyrate measurements in emergency department in patients without diabetes: a systematic review

Study

Country; sites; recruitment dates

Number analysed; age range (median/mean) at recruitment

Population

Details of intervention

Primary outcome of study

Other outcomes measured

O'Donohoe et al. (2006) [12]

Edinburgh, United Kingdom; single site; November to January

186; 0–154 (median 35.5, IQR 12.0–74.5) months

Convenience sample of patients (< 13 years) presenting to the ED with medical problems requiring blood testing as part of their medical investigations

Venous blood at time of venepuncture BHB using POC MediSense Optium System by Abbott Laboratories, Berkshire, UK

Pattern of BHB levels, Predicting admission vs discharge

Illness severity, Feeding patterns

Durnin et al. (2020) [18]

Dublin, Ireland; single site; April 2016 to February 2017

198; 2 months- 4.99 years (median 1.8 years)

Patients (aged 1 month–5 years) presenting to the paediatric ED with symptoms of vomiting and/or diarrhoea and/or decreased fluid intake with a 4-point Gorelick Scale of 2 or greater or concern at triage of possible hypoglycemia

Capillary blood at triage and 4 h later, BHB using POC Abbott Precision Xceed Pro system (Libertyville, IL, USA)

Relationship between triage POC BHB and the two Gorelick scores

Triage POC BHB and ED admission vs discharge, Triage POC BHB and presenting symptom duration

Levy et al. (2013) [19]

Boston, USA; single site; November 2007 to December 2010

188; median 2.3 years (IQR 1.2–3.5 years)

Patients (aged 6 months–6 years) presenting to the paediatric ED with symptoms of gastroenteritis and were to receive IV fluids for dehydration

Blinded. Venous blood at time of intravenous cannulation. BHB using POC Precision Xtra blood ketone monitoring system (Abbott Laboratories, Libertyville, IL)

Relationship between serum BHB and degree of dehydration, Relationship between serum BHB and degree of metabolic acidosis via serum bicarbonate concentration

Relationship between serum BHB and prospectively assigned appearance score; serum glucose; and duration of symptoms

Pikija et al. (2013) [23]

Varaždin, Croatia; single site; September 1, 2011 to November 30, 2011

51; 31–90 (median 77) years

Adult patients (≥ 18 years) with verified first-ever acute stroke

At presentation capillary blood BHB using POC Precision Xceed Pro β-ketone Monitoring system (Abbott Diabetes Care, Alamedia, CA, USA)

Relationship between capillary BHB and stroke severity (NIHSS score), Relationship between capillary BHB and disability prevalence (mRS score)

-

Torres et al. (2018) [20]

Valladolid, Spain; single site; December 1, 2015 to November 30, 2016

233; 2.9 months to 14.17 years (mean 5.33 years)

Patients (≤ 14 years) who had ≥ 3 vomiting episodes in the last 4 h prior to ED presentation

After initial examination capillary blood BHB (no other details)

Relationship between capillary BHB and failure of oral rehydration

-

Montero et al. (2022) [22]

Navarra; Spain; single site; February to December 2021

151; 2 groups analysed separately-group 1 mean 11.21 years (SD 2.64), group 2 mean 9.87 years (SD 3.08)

Patients (0–14 years) presenting to the paediatric ED with acute abdominal pain suggestive of acute appendicitis with at least 5 days of evolution and association with at least one of the following symptoms: hyporexia, nausea, vomiting, febrile fever, diarrhoea

Capillary blood at time of inclusion in study, on arrival at the paediatric ED, and before initiating intravenous hydration using blood beta-ketone test strip by Abbott Diabetes Care Ltd. analysed by FreeStyle Optimum Neo device

Relationship between capillary BHB and the diagnosis of paediatric acute appendicitis

Number of emetic episodes, days of admission

Lee et al. (2019) [21]

Seoul, South Korea; single site; June 2015 to December 2018

42; mean 21.0 months (SD 11.5 months)

Patients 6 months–6 years of age diagnosed with benign convulsions with mild gastroenteritis

Venous blood BHB (no other information)

Frequency of ketosis in children with benign convulsions with mild gastroenteritis, relationship between ketosis severity and gastroenteritis or seizures

Gastroenteritis symptoms ≥ 4 days, number of seizures before and after ED arrival, and admission to ward