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.

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