Evidence map›Paper›PMID 42082783›Full record

ArticleActa diabetologica2026

High-fidelity simulation-based validation of applicability of the new Italian society for pediatric endocrinology and diabetes (ISPED) recommendations for pediatric diabetic ketoacidosis management.

Ivana Rabbone, Andrea Scaramuzza, Erica Pozzi, Elena Corti, Alice Monzani, Federico Lorenzo Barra, Massimo Canonico, Luisa Fernanda Barrera Leon, Marta Bassi, Riccardo Bonfanti and 13 more

Abstract readValidation Study
PubMed Publisher
In one paragraph

Article in Acta diabetologica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Ivana RabboneDivision of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Andrea ScaramuzzaDivision of Pediatrics, Pediatric Diabetes, Endocrinology and Nutrition, Azienda Socio Sanitaria Territoriale (ASST) Cremona, Ospedale Maggiore, Viale Concordia 1,, 26100, Cremona, Italy. andrea.scaramuzza@hsacco.it.ORCID http://orcid.org/0000-0002-1518-8515
Erica PozziDivision of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Elena CortiDivision of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Alice MonzaniDivision of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Federico Lorenzo BarraSIMNOVA-Interdepartmental Center for Innovative Learning and Simulation in Medicine and Allied Health Professions, University of Piemonte Orientale, Novara, Italy.
Massimo CanonicoDepartment of Sciences and Technological Innovation, University of Piemonte Orientale, Alessandria, Italy.
Luisa Fernanda Barrera LeonDepartment of Sciences and Technological Innovation, University of Piemonte Orientale, Alessandria, Italy.
Marta BassiDepartment of Neuroscience Rehabilitation Ophthalmology Genetics, Maternal and Child Health, University of Genoa, Genova, Italy.
Riccardo BonfantiPediatric Diabetes Unit, Department of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
Francesca Di CandiaDepartment of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy.
Giulio FrontinoPediatric Diabetes Unit, Department of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy.
Dario IafuscoDepartment of Woman, Child and General and Specialistic Surgery, Regional Center of Pediatric Diabetes, University of Campania L. Vanvitelli, Naples, Italy.
Fortunato LombardoDepartment of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy.
Maddalena MacedoniDepartment of Pediatrics, Università di Milano, Buzzi Children's Hospital, Milan, Italy.
Valentina MancioppiDepartment of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Marco MariglianoDepartment of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Mariangela MartinoEndocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Riccardo SchiaffiniEndocrinology and Diabetes Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Valentina TiberiDepartment of Women's and Children's Health, Azienda Ospedaliero- Universitaria, Ospedali Riuniti di Ancona, G. Salesi Hospital, Ancona, Italy.
Davide TintiCentro di Diabetologia Pediatrica, A.O. "Ospedale Infantile Regina Margherita", Torino, Italy.
Sonia ToniDiabetology and Endocrinology Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Valentino CherubiniDepartment of Women's and Children's Health, Azienda Ospedaliero- Universitaria, Ospedali Riuniti di Ancona, G. Salesi Hospital, Ancona, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimTo use high-fidelity simulation to validate the clinical applicability and safety of the recently updated Italian Society for Pediatric Endocrinology and Diabetes (ISPED) recommendations for the management of diabetic ketoacidosis (DKA).

methodsExpert pediatric diabetologists participated in a full-day simulation session. Teams of four managed three advanced scenarios on a pediatric manikin: severe DKA, DKA with cerebral edema, and DKA with acute kidney injury (AKI). During the scenarios, teams utilized the new guidelines as a paper protocol, a digital application, and an AI chatbot. Each session was followed by a structured debriefing to analyze decisions, protocol adherence, and user experience, with feedback collected via questionnaires and discussion.

resultsThe simulation confirmed the overall robustness and clinical validity of the new guidelines. Participants appreciated the increased detail on managing complications like cerebral edema and AKI. A key learning point emerged regarding uncertainty in the initial choice of fluids (normal saline vs. Ringer’s lactate). A quantitative analysis of user experience revealed a statistically significant preference for the paper protocol, which outperformed digital versions on key usability metrics, including efficiency and dependability (p < 0.001). The AI chatbot, despite being rated as highly novel, was perceived as impractical and inefficient.

conclusionHigh-fidelity simulation is an effective methodology for prospectively validating and refining clinical practice guidelines in a controlled environment before official release. We confirm the validity of the new ISPED recommendations while identifying key areas for targeted training and the need for the user-centered design of digital support tools.

Indexed as

Diabetic KetoacidosisBrain EdemaChildEndocrinologyHumansItalyManikinsPediatricsPractice Guidelines as TopicSocieties, MedicalClinical guidelinesDiabetic ketoacidosisHigh-fidelity simulationMedical educationPatient safetyPediatricsQuality improvement.

Identifiers

PMID42082783

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.