Impact of Evidence-Based Practice Nursing Guideline on Clinical Outcomes in Children with Diabetic Ketoacidosis: A Quasi-Experimental Study

Vollständiger Abstract

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Background: Diabetic Ketoacidosis (DKA) is a potentially life-threatening complication of diabetes and it is one of the most common causes of death in children with Type 1 Diabetes Mellitus (T1DM). While international management protocols are available, Iraq lacks a standardized local nursing guideline for children with DKA. Objective: To evaluate the effectiveness of Evidence-Based Practice (EBP) nursing guidelines on clinical outcomes in children with DKA. Method: A quasi-experimental design was conducted for the study between May 2025 to January 2026. A total of 60 children, aged 6–16, diagnosed with DKA, were allocated into two groups of 30. One group, the control, received routine hospital care and the other, the intervention group, was managed using an EBP nursing guideline. The outcome measures included biochemical recovery, the duration to DKA resolution, the length of hospitalization, complications and the assessment after two months of discharge. Results: Compared to the control group, the intervention group showed a significantly greater reduction in blood glucose (mean difference: -166.93 mg/dL; p<0.001) and shorter DKA resolution time (median: 18 Vs 27 hours; p<0.001, r = 0.636), shorter hospital stays (2 Vs 3 days, p<0.001), lower persistent acidosis (16.7% Vs 80.0%; p<0.001) and fewer multiple complications (30.0% Vs 63.3%; p<0.007). Finally, the readmission rates were significantly lower in the intervention group (34.5% Vs 65.5%; p<0.019). Conclusion: The findings showed that implementing an EBP nursing guideline for pediatric DKA resulted in enhanced metabolic recovery, a decrease in complications and a reduction in readmission rates. According to these results, using structured nursing care and supported by EBP nursing guidelines in emergency settings positively affects the clinical outcomes of children with DKA.