P0506 - Emergency Department Trends for Pediatric Diabetic Ketoacidosis Visits

Background/Purpose: Diabetes mellitus type 1 (T1DM), is a prevalent disease, with increasing incidence noted worldwide. It is reasonable to hypothesize that emergency department (ED) visits for diabetic ketoacidosis (DKA) in pediatric patients within the United States (US) are increasing. Conversely, with advances in technology and public knowledge about diabetes, there may be fewer ED visits for DKA in patients with known T1DM. The purpose of this study was to evaluate changes over time in T1DM DKA visits and the proportion of visits for DKA in children with T1DM within US EDs.

Methods: We conducted a retrospective cohort study of children ages <18 years using the Healthcare Costs and Utilization Project, Nationwide Emergency Department Sample database from 2007-2016. ED visits with an ICD code for T1DM were included. We excluded visits for Secondary Diabetes Mellitus, Type II Diabetes Mellitus, and Other Specified Diabetes Mellitus. We also excluded visits that resulted in a transfer to an acute care facility to avoid double counting. We calculated rates of visits for T1DM and DKA relative to all ED visits and relative to the US population of comparably aged children over the same time period. The proportion of T1DM visits relative to all ED visits and the US population, and the proportion DKA visits relative to T1DM were also evaluated. Trends were evaluated using linear regression. ED disposition and hospital characteristics for DKA visits were also explored.

Results: US population rates of pediatric ED visits for T1D increased by 25.4% (p=0.0018) over the study period. While there was a 5.8% (p=0.0012) increase in the proportion of T1DM among all ED visits, DKA visits as a proportion of T1DM visits decreased by 8.0% (p=0.00001). The proportion of DKA visits resulting in admission remained unchanged over the study period. There was a shift in DKA visits from non-metropolitan, non-teaching metropolitan, and lower volume centers to high volume (18.1%; p=0.02) metropolitan teaching (21.0%; p=0.0) centers. The proportion of DKA visits that were at children’s hospitals was unchanged.

Conclusion: Consistent with the increased population prevalence of T1DM, we found an increased incidence of ED visits for T1DM over our study period. However, there was a decrease in the proportion of T1DM ED visits that were associated with DKA and no change in DKA admission rates. Further research is needed to determine what factors are influencing ED care seeking for T1DM.