Etiologies, trends, and predictors of
            <scp>30‐day</scp>
            pediatric readmissions after hospitalizations for diabetic ketoacidosis in the United States

Bhatt, Parth; Dave, Maneesh; Amponsah, Jason K.; Jain, Apurva; Yagnik, Priyank; Asare‐Afriyie, Barbara; Donda, Keyur; Sharma, Mayank; Parmar, Narendrasinh; Patel, Achint; Bhatt, Neel S.; Lunsford, Alison; Dapaah‐Siakwan, Fredrick

doi:10.1111/pedi.13059

Cited by 11 publications

(11 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…NRD represents 49% of total US hospitalizations [ 7 ]. Patients were tracked using variable “NRD_Visitlink” used to verify patient linkage number for linking hospital visits for the same patient across hospitals and time between two admissions was calculated by subtracting time variable “NRD_DaysToEvent.” Time to readmission was calculated by subtracting the length of stay (LOS) of primary admissions to time between 2 admissions [ 8 - 9 ]. National estimates are produced using sampling weights provided by the NRD.…”

Section: Methodsmentioning

confidence: 99%

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States

Shah¹,

Mansuri

Pagad

et al. 2020

Cureus

View full text Add to dashboard Cite

Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States

Shah¹,

Mansuri

Pagad

et al. 2020

Cureus

View full text Add to dashboard Cite

show abstract

“…Whereas the outcome of DKA has improved tremendously over the last decades, 4,30 the incidence remained stable, and recurring events or readmission to a hospital are frequent concerns 15,18,22‐24,31 . Previous studies of repetitive DKA events were designed as case–control‐studies, 30 analyzed only a group of patients with DKA‐related hospital admissions, covered a shorter period of time 18,19,24 or a smaller group of patients. To our knowledge, this is the first population‐based study of a large pediatric cohort over a long period of time that emphasizes the role of previous episodes and their time‐lag as independent risk factor for DKA, which acts independently of the patients' age, sex, and treatment modality.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies have shown an association of DKA with psychiatric comorbidity and substance abuse in adults and children 24,30,39‐43 . DKA frequency is significantly increased in girls with T1D and eating disorders 44 .…”

Section: Discussionmentioning

confidence: 99%

“…Since DKA mortality is higher in patients with several episodes, 22 patients with relapsing DKA require special awareness. Growing up in a deprived area especially predisposes pediatric T1D patients to repetitive DKA 23 ; moreover, females, adolescents, and patients with psychiatric comorbidity are more likely to be readmitted for DKA within 30 days after discharge 24 . The role of previous episodes as an independent risk factor for acute T1D complications is increasingly understood: an episode of severe hypoglycemia increased the recurrence rate in pediatric patients with T1D even years later 25 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative

et al. 2021

View full text Add to dashboard Cite

Objective To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time‐lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). Research Design and Methods In a population‐based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow‐up were retrieved from the “Diabetes Prospective Follow‐up” (DPV) multi‐center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. Results Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3–4.6] per 100 patient‐years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9–19.5] vs. 2.8 [2.7–3.1] per 100 patient‐years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6–11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6–3.1]; p < 0.001). Conclusions Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow‐up after each episode.

show abstract

“…Our study found a readmission rate of 4.3% in 2017, which has not changed dramatically from that of prior years, though it is lower than the all-cause readmission rate. The mean LOS in that study for those with readmission versus those without was 2.77 and 2.45 days, respectively [ 32 ]. In our study, the mean LOS of those with readmission versus no readmission was 2.06 versus 2.28 days.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors, Trends, and Preventive Measures for 30-Day Unplanned Diabetic Ketoacidosis Readmissions in the Pediatric Population

Vasireddy¹,

Sehgal²,

Amritphale³

2021

Cureus

View full text Add to dashboard Cite

Background There has been a steady rise in types 1 and 2 diabetes mellitus among the youth in the USA from 2001 to 2017. Diabetic ketoacidosis (DKA) is a common and preventable presentation of both types of diabetes mellitus. According to the Centers for Disease Control and Prevention’s (CDC) United States Diabetes Surveillance System, during 2004-2019 an increase in DKA hospitalization rates by 59.4% was noted, with people aged less than 45 years having the highest rates. Readmissions reflect the quality of disease management, which is integrally tied to care coordination and communication with the patient and their families. This study analyzes the trends and risk factors contributing to 30-day unplanned DKA readmissions in the pediatric age group and looks into possible preventive measures to decrease them. Methods A retrospective study was performed using the National Readmission Database (NRD) from January 1, 2017, to December 1, 2017. Pediatric patients aged 18 years and younger with the primary diagnosis of DKA were included using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code E10.10. All statistical analysis was performed using IBM SPSS Statistics for Windows, version 1.0.0.1327 (IBM Corp., Armonk, NY, USA). Pearson’s chi-square test was used for categorical variables and Mann-Whitney U test was used for continuous variables. To independently determine the predictors of readmission within each clinical variable, multiple logistic regressions with values presented as odds ratios (OR) with 95% confidence intervals (CI) were performed. Results A weighted total of 19,519 DKA-related pediatric index admissions were identified from the 2017 NRD. Of these pediatric patients, 831 (4.3%) had 30-day DKA readmission. The median age of a child for readmission was 16 years with an interquartile range of 0 to 18 years. A sharp rise in 30-day DKA readmissions was noted for ages 16 years and over. Females in the 0-25th percentile median household income category, with Medicaid covered, large metropolitan areas with at least 1 million residents, and metropolitan teaching hospitals were found to have a statistically significant higher percentage of readmissions. The mean length of stay for those who had a DKA readmission was 2.06 days, with a standard deviation of 1.84 days. The mean hospital charges for those who had a DKA readmission were $ 20,339.70. The 30-day DKA readmission odds were seen to be increased for female patients, Medicaid-insured patients, admissions at metropolitan non-teaching hospitals, and children from 0-25th percentile median household income category. Conclusion There has not been much of a change in the trend and risk factors contributing to the 30-day unplanned DKA readmissions over the years despite the steady rise in cases of diabetes mellitus. The length of stay for those who did not get readmitted within 30 days was longer than for those who did. This could ...

show abstract

Etiologies, trends, and predictors of 30‐day pediatric readmissions after hospitalizations for diabetic ketoacidosis in the United States

Cited by 11 publications

References 43 publications

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States

Rate and Modifiable Predictors of 30-Day Readmission in Patients with Acute Respiratory Distress Syndrome in the United States

Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative

Risk Factors, Trends, and Preventive Measures for 30-Day Unplanned Diabetic Ketoacidosis Readmissions in the Pediatric Population

Contact Info

Product

Resources

About