Emergency Medical Services Use of Capillary Ketone Meters for SuspectedDiabetic Ketoacidosis: A Systematic Review
Keywords:
Emergency Medical Services, Diabetic Ketoacidosis, β-Hydroxybutyrate, Point-of-Care Testing, Prehospital Care, Diagnostic PathwaysAbstract
Background: Diabetic ketoacidosis is a time-critical emergency; emergency medical services (EMS) may benefit from capillary β-hydroxybutyrate testing to improve recognition and trigger early care pathways.
Methods: PubMed, Scopus, citation lists, and trial registries were searched from inception to 30 September 2024 for clinical trials and cohort studies evaluating EMS-performed capillary ketone measurement in suspected diabetic ketoacidosis. Dual screening, duplicate data extraction, and designappropriate risk-of-bias tools (QUADAS-2/JBI) were used. A narrative synthesis was conducted without meta-analysis.
Results: Of 263 records identified, 71 duplicates were removed; 192 titles/abstracts were screened, 29 full texts were assessed, and 1 stepped-wedge feasibility cohort was included. The multicentre United Kingdom study enrolled 388 EMS encounters (control 203; intervention 185) and implemented a “highrisk DKA” bundle triggered by capillary β-hydroxybutyrate ≥3.0 mmol/L. Recognition of suspected highrisk diabetic ketoacidosis increased from 2.5% (5/203) to 6.5% (12/185), a +4.0 percentage-point difference. Among hospital-diagnosed cases, prehospital crystalloid initiation rose from 33.3% (3/9) to 45.5% (5/11). Hospital pre-alerting increased qualitatively, while scene-time effects were not reported. No device-related serious adverse events were described; paramedic and emergency-department staff reported the approach as feasible and acceptable. Large contextual cohorts without prehospital ketone testing were excluded but highlighted the implementation gap.
Conclusions: EMS capillary ketone testing appeared feasible and was associated with improved early recognition and pre-arrival actions, though evidence was limited to a single underpowered feasibility cohort. Protocolized implementation with audit is reasonable, and multicentre effectiveness studies reporting patient-centred outcomes are needed.
