Variation in use of intensive care for adults with diabetic ketoacidosis*.

Critical Care Medicine
Hayley B GershengornHannah Wunsch

Abstract

Intensive care unit beds are limited, yet few guidelines exist for triage of patients to the intensive care unit, especially patients at low risk for mortality. The frequency with which low-risk patients are admitted to intensive care units in different hospitals is unknown. Our objective was to assess variation in the use of intensive care for patients with diabetic ketoacidosis, a common condition with a low risk of mortality. Observational study using the New York State In-patient Database (2005-2007). One hundred fifty-nine New York State acute care hospitals. Fifteen thousand nine hundred ninety-four adult (≥ 18) hospital admissions with a primary diagnosis of diabetic ketoacidosis (International Classification of Diseases, Ninth Revision, Clinical Modification 250.1x). None. We calculated reliability- and risk-adjusted intensive care unit utilization, hospital length of stay, and mortality. We identified hospital-level factors associated with increased likelihood of intensive care unit admission after controlling patient characteristics using multilevel, mixed-effects logistic regression analyses; we assessed the amount of residual variation in intensive care unit utilization using the intraclass correlation coefficient. ...Continue Reading

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