Session: OR11-Pediatric Endocrinology
Room 104 (Moscone Center)
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
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