Paul Martinez, MD
Assistant Professor
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Prithvi Raj Sendi, MD
Nicklaus Children's Hospital
Miami, Florida
Disclosure information not submitted.
Balagangadhar Totapally, MBBS, MD, DCH, MRCP, FAAP, FCCP, FCCM
Chief, Division of Critical Care Medicine. Program Director, Critical Care Fellowship Program
Nicklaus Children's Hospital, United States
Disclosure information not submitted.
Title: Epidemiology and Outcomes of Children with Diabetic Ketoacidosis with Cerebral Edema from 1997-2016
Introduction: Diabetic ketoacidosis (DKA) is the most common reason for hospitalization of children with type 1 diabetes mellitus (T1DM), and cerebral edema is its most serious complication. The goal of this study was to assess for temporal changes in prevalence and mortality in hospitalized children with DKA, with and without cerebral edema.
Methods: This was a longitudinal retrospective analysis of the Healthcare Cost and Utilization Project’s Kids’ Inpatient Database for the years 1997 to 2016. T1DM with DKA and related diagnoses and procedures were identified with appropriate ICD 9 and 10 codes. Children from 1 month through 18 years of age were included. Descriptive statistics are presented as percentages. Inferential statistics are presented as OR with 95% CI. P value < 0.05 is considered statistically significant. SPSS v.27 (IBM) and StatCalc, OpenEpi (CDC) were used for statistical and trend analyses, respectively.
Results: In the United States, a total of 161,884 out of 21,099,684 children from 1 month through 18 years were discharged from the hospital with the diagnosis of T1DM with DKA from 1997 to 2016. Cerebral edema was documented in 929 (5.7/1,000) DKA discharges. The majority of hospitalized children with DKA and cerebral edema were female (57%) and White (56%), however there were disproportionately more Black children with cerebral edema. The mortality rate for hospitalized children with DKA and cerebral edema was 6.4% compared to a mortality rate in those with DKA without cerebral edema of 0.1% (OR: 96; 95% CI: 63-145). From 1997 to 2016 the prevalence of DKA in hospitalized children increased from 0.6% to 1.6% (p < 0.001) while the prevalence of cerebral edema in hospitalized children with DKA increased from 0.4 to 1.1% (p < 0.001). During this same period, the mortality rate for hospitalized children with DKA and cerebral edema decreased from 9.1% to 4.4% (P=0.003).
Conclusions: The prevalence of cerebral edema in hospitalized children with DKA in the United States increased from 1997 to 2016. However, during the same period, the mortality rate for hospitalized children with DKA and cerebral edema decreased. Hospitalized children with DKA and cerebral edema have a significantly higher mortality compared to those with DKA without cerebral edema.