Abstract Title

Readmission Rates for Children with Diabetic Ketoacidosis (DKA)

Presenter Name

Todd Jarvis

RAD Assignment Number

803

Abstract

Background: Ketoacidosis is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Criteria for admission varies and could influence the rate of readmissions.

Objective: To describe the population and compare readmission rates of patients treated at Cook Children’s ED for DKA.

Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – August 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection.

Results: 313 children were seen in the ED with a diagnosis of DKA. Of the total patients seen in the ED, 14% were discharged for home management after initial assessment and treatment; 86% were admitted to the hospital. Of the patients discharged, a median 5.2 hours was spent in the ED. Discharged patients had a median glucose of 285 mg/dL (nl. 74-120 mg/dL), median pH of 7.3 (nl. 7.35-7.45), and median HCO3 of 20.4 mEq/L (nl. 22-28 mEq/L). Of the patients admitted, a median 3.6 hours was spent in the ED. Admitted patients had a median glucose of 437 mg/dL, median pH of 7.2, and median HCO3 of 11.2 mEq/L.

Conclusions: DKA is defined as 1) metabolic acidosis (pH < 7.3; HCO3 < 15 mEq/L); 2) hyperglycemia (serum glucose > 200 mg/dL); and 3) ketonemia/ketonuria. It occurs frequently among youth with diabetes and is the main cause of mortality in individuals with diabetes < 24 years of age. DKA is more common in those with T1D, but can also be seen in children with T2D. The metabolic changes in DKA usually occur rapidly and can be fatal, primarily due to cerebral edema.

Of the 313 children seen in the ED from September 2011 — August 2014, a large majority were admitted from the ED. Glucose levels of admitted patients (437 mg/dL) were 53% higher than discharged patients (285 mg/dL). Admitted patients HCO3 levels (11.2 mEq/L) were 45% lower than discharged patients (20.4 mEq/L).

Of the 45 discharged from the ED, 16% returned to the ED within 90 days for DKA, while only 7% of the 268 children admitted returned.

In the US, DKA is present in up to 40% of youth with new-onset diabetes. A recent study found 1 in 5 children were re-admitted for DKA within 1 year of a previous occurrence, with large variations in treatment for DKA within Children’s Hospitals located in the US. These studies illustrate the need to identify children who are at risk for DKA and to develop effective interventions for prevention of DKA.

A better understanding of the characteristics of children with DKA and treatment/disposition strategies used by ED physicians can help improve care of those treated in the ED.

Research Area

Diabetes

Presentation Type

Poster

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Readmission Rates for Children with Diabetic Ketoacidosis (DKA)

Background: Ketoacidosis is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Criteria for admission varies and could influence the rate of readmissions.

Objective: To describe the population and compare readmission rates of patients treated at Cook Children’s ED for DKA.

Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – August 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection.

Results: 313 children were seen in the ED with a diagnosis of DKA. Of the total patients seen in the ED, 14% were discharged for home management after initial assessment and treatment; 86% were admitted to the hospital. Of the patients discharged, a median 5.2 hours was spent in the ED. Discharged patients had a median glucose of 285 mg/dL (nl. 74-120 mg/dL), median pH of 7.3 (nl. 7.35-7.45), and median HCO3 of 20.4 mEq/L (nl. 22-28 mEq/L). Of the patients admitted, a median 3.6 hours was spent in the ED. Admitted patients had a median glucose of 437 mg/dL, median pH of 7.2, and median HCO3 of 11.2 mEq/L.

Conclusions: DKA is defined as 1) metabolic acidosis (pH < 7.3; HCO3 < 15 mEq/L); 2) hyperglycemia (serum glucose > 200 mg/dL); and 3) ketonemia/ketonuria. It occurs frequently among youth with diabetes and is the main cause of mortality in individuals with diabetes < 24 years of age. DKA is more common in those with T1D, but can also be seen in children with T2D. The metabolic changes in DKA usually occur rapidly and can be fatal, primarily due to cerebral edema.

Of the 313 children seen in the ED from September 2011 — August 2014, a large majority were admitted from the ED. Glucose levels of admitted patients (437 mg/dL) were 53% higher than discharged patients (285 mg/dL). Admitted patients HCO3 levels (11.2 mEq/L) were 45% lower than discharged patients (20.4 mEq/L).

Of the 45 discharged from the ED, 16% returned to the ED within 90 days for DKA, while only 7% of the 268 children admitted returned.

In the US, DKA is present in up to 40% of youth with new-onset diabetes. A recent study found 1 in 5 children were re-admitted for DKA within 1 year of a previous occurrence, with large variations in treatment for DKA within Children’s Hospitals located in the US. These studies illustrate the need to identify children who are at risk for DKA and to develop effective interventions for prevention of DKA.

A better understanding of the characteristics of children with DKA and treatment/disposition strategies used by ED physicians can help improve care of those treated in the ED.