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Presenting predictors and temporal trends of treatment‐related outcomes in diabetic ketoacidosis
Author(s) -
Horvat Christopher M,
Ismail Heba M,
Au Alicia K,
Garibaldi Luigi,
Siripong Nalyn,
Kantawala Sajel,
Aneja Rajesh K,
Hupp Diane S,
Kochanek Patrick M,
Clark Robert SB
Publication year - 2018
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/pedi.12663
Subject(s) - medicine , diabetic ketoacidosis , cerebral edema , blood pressure , retrospective cohort study , hypoglycemia , confidence interval , hyperchloremia , diabetes mellitus , pediatrics , insulin , acidosis , endocrinology
Objective This study examines temporal trends in treatment‐related outcomes surrounding a diabetic ketoacidosis (DKA) performance improvement intervention consisting of mandated intensive care unit admission and implementation of a standardized management pathway, and identifies physical and biochemical characteristics associated with outcomes in this population. Methods A retrospective cohort of 1225 children with DKA were identified in the electronic health record by international classification of diseases codes and a minimum pH less than 7.3 during hospitalization at a quaternary children's hospital between April, 2009 and May, 2016. Multivariable regression examined predictors and trends of hypoglycemia, central venous line placement, severe hyperchloremia, head computed tomography (CT) utilization, treated cerebral edema and hospital length of stay (LOS). Results The incidence of severe hyperchloremia and head CT utilization decreased during the study period. Among patients with severe DKA (presenting pH < 7.1), the intervention was associated with decreasing LOS and less variability in LOS. Lower pH at presentation was independently associated with increased risk for all outcomes except hypoglycemia, which was associated with higher pH. Patients treated for cerebral edema had a lower presenting mean systolic blood pressure z score (0.58 [95% confidence interval (CI) −0.02‐1.17] vs 1.23 [1.13‐1.33]) and a higher maximum mean systolic blood pressure (SBP) z score during hospitalization (3.75 [3.19‐4.31] vs 2.48 [2.38‐2.58]) compared to patients not receiving cerebral edema treatment. Blood pressure and cerebral edema remained significantly associated after covariate adjustment. Conclusion Treatment‐related outcomes improved over the entire study period and following a performance improvement intervention. The association of SBP with cerebral edema warrants further study.