OR11-3 Patient Characteristics Associated with Readmission for Diabetic Ketoacidosis at U.S. Children's Hospitals

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR11-Pediatric Endocrinology
Clinical
Saturday, June 15, 2013: 11:30 AM-1:00 PM
Presentation Start Time: 12:00 PM
Room 104 (Moscone Center)
Faisal S Malik*1, Rajendu Srivastava2, Russell Localio3, Lisa McLeod3, Ron Keren3, Xianqun Luan3, Sanjay Mahant4, Samir S Shah5, Karen M Wilson6, Joel S Tieder1 and For the Pediatric Research in Inpatient Settings (PRIS) Network7
1University of Washington and Seattle Children's Hospital, Seattle, WA, 2University of Utah Health Sciences Center, Salt Lake City, UT, 3Children's Hospital of Philadelphia, Philadelphia, PA, 4University of Toronto, Toronto, ON, 5Cincinnati Children's Hospital Medical Center, Cincinatti, OH, 6Children's Hospital Colorado, Aurora, CO, 7PRIS Network
Background: Hospital readmission for diabetic ketoacidosis (DKA) is preventable, yet it remains extremely common. Our goal was to examine patient characteristics associated with higher rates of readmission for DKA at major U.S. children’s hospitals.

Methods: Multi-center retrospective cohort study of children 2-18 years of age admitted to 38 freestanding children’s hospitals participating in the Pediatric Health Information Systems (PHIS) database between January 2004 and December 2009 with a discharge diagnosis code for DKA and that received insulin. We used a logistic regression model to evaluate patient characteristics and the odds of readmission at 30 and 365 days, and predictive margins to measure the average chance of readmission for children with each characteristic. Covariates included age, public insurance, complex care conditions, mental health conditions, and severity of illness at the index visit.

Results: Of the 24,890 children with DKA, 55.3% were female, 7.3% were <5 years, 57.4% were >12 years, 43.1% had government insurance, and 9.4% had mental health condition(s). Readmission rate for DKA was 2.8% at 30 days and 20.3% at 365 days after discharge. Overall, higher risk of readmission was associated with age >12 years (30 days: OR, 1.8; 95% CI, 1.4-2.3; 365 days: OR 2.6; 95% CI, 2.3-2.9), public insurance (30 days: OR, 1.8; 95% CI, 1.4-2.3; 365 days: OR 1.7; 95% CI, 1.6-2.0), and a diagnosis of a mental health condition (30 days: OR, 1.8; 95% CI, 1.4-2.3; 365 days: OR 1.7; 95% CI, 1.6-2.0).  Children <5 years were less likely to be readmitted for DKA (30 days: OR, 0.2; 95% CI, 0.1-0.4; 365 days: OR 0.3; 95% CI, 0.2-0.4).  Females >12 years of age and with public insurance had a 40% average chance for readmission compared to 2.1% for boys under age 5 with private insurance at 365 days.

Conclusion: In a large sample of freestanding children’s hospitals, adolescents, females, and the publically insured had the highest risk for hospital readmission at both 30 and 365 days. These data may be used to target interventions for DKA prevention toward the most vulnerable populations.

Nothing to Disclose: FSM, RS, RL, LM, RK, XL, SM, SSS, KMW, JST, FTPRIISN

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: The management, analysis, and interpretation of the data for this project were supported by a Health Research Formula Grant from the Pennsylvania Department of Public Health Commonwealth Universal Research Enhancement (C.U.R.E.) Program (SAP#4100050891) and a grant from Child Health Corporation of America.