Hospital Admission Rates for Children with Diabetic Ketoacidosis (DKA)

Background and Objective: Diabetic Ketoacidosis (DKA) is a potentially life threatening complication of diabetes mellitus. Emergency Departments (ED) are usually the first point of contact. Following stabilization in the ED, patients are generally discharged home for outpatient management or hospitalized for continued care. Our objective is to gain a better understanding of the patient characteristics and treatment/disposition strategies used by ED physicians to improve care of children with DKA. Methods: A retrospective chart review was preformed of children seen in the Cook Children’s Medical Center ED from September 2011 – Aug 2014. No attempt was made to classify patients as T1 vs T2. APR-DRG 420 (diabetic ketoacidosis) was used for subject selection. Results: During the study, 401 children were seen in the ED with a diagnosis of DKA. Ten percent (40) of patients were transferred from an outside facility to the ED for assessment and treatment; 90% (361) were not transferred. Of the total patients seen in the ED, 16.2% (65) were discharged for home management after initial assessment and treatment (1 transfer; 64 non-transferred); 83.8% (336) were admitted to the hospital (transfer 39; non-transfer 297). Of the patients who were admitted, the majority (66.9%) were admitted to the inpatient unit (inpatient 225 vs. PICU 111). Conclusion: A large number of children with DKA are evaluated and treated in Emergency Departments. Continuing research on the characteristics of these children and the treatment strategies used by ED physicians can help improve care of children with DKA.