Comparison of outcomes and costs between adult diabetic ketoacidosis patients admitted to the ICU and step-down unit

Shannon M Fernando; Sean M Bagshaw; Bram Rochwerg; Daniel I McIsaac; Kednapa Thavorn; Alan J Forster; Alexandre Tran; Peter M Reardon; Erin Rosenberg; Peter Tanuseputro; Kwadwo Kyeremanteng

doi:10.1016/j.jcrc.2018.12.014

Comparison of outcomes and costs between adult diabetic ketoacidosis patients admitted to the ICU and step-down unit

J Crit Care. 2019 Apr:50:257-261. doi: 10.1016/j.jcrc.2018.12.014. Epub 2018 Dec 25.

Authors

Affiliations

¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: sfernando@qmed.ca.
² Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
³ Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁴ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁵ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁶ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
⁸ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
⁹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
¹⁰ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada.
¹¹ Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Institut du Savoir Montfort, Ottawa, ON, Canada.

PMID: 30640078
DOI: 10.1016/j.jcrc.2018.12.014

Abstract

Purpose: There is wide variation in the utilization of Intensive Care Unit (ICU) beds for treatment and monitoring of adult patients with Diabetic Ketoacidosis (DKA). We sought to compare the outcomes and hospital costs of adult DKA patients admitted to ICUs as compared to those admitted to step-down units.

Materials and methods: We included consecutive adult patients from two hospitals with a diagnosis of DKA. Patients were either admitted to the ICU, or a step-down unit, which has a nurse-to-patient ratio of 2:1, but does not have capability for mechanical ventilation or administration of vasoactive agents. The primary outcome was in-hospital mortality.

Results: We included 872 patients in the analysis. 71 (8.1%) were admitted to ICU, while 801 (91.9%) were admitted to a step-down unit. We found no difference in in-hospital mortality between patients admitted to the ICU and those admitted to the step-down unit (adjusted odds ratio [OR]: 1.14, 95% confidence interval [CI]: 0.87-2.64). Mean total hospital costs were significantly higher for patients admitted to the ICU ($20,428 vs. $6484, P < 0.001).

Conclusions: Adult DKA patients admitted to a step-down unit had comparable in-hospital mortality and lower hospital costs as compared to those admitted to the ICU.

Keywords: Costs; Diabetic ketoacidosis; Endocrinology; Health economics; Intensive care unit; Intermediate care; Step-down units.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Adult
Costs and Cost Analysis
Diabetic Ketoacidosis / economics
Diabetic Ketoacidosis / mortality*
Diabetic Ketoacidosis / therapy
Female
Hospital Mortality*
Humans
Intensive Care Units / organization & administration*
Male
Middle Aged
Outcome Assessment, Health Care
Retrospective Studies