HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Curtis, J. R. Articles by Daneman, D. Search for Related Content PubMed PubMed Citation Articles by Curtis, J. R. Articles by Daneman, D. Social Bookmarking                What's this?

Recent Trends in Hospitalization for Diabetic Ketoacidosis in Ontario Children

¹ Department of Pediatrics, Division of Endocrinology, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
² Population Health Sciences Program, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
³ Department of Pediatrics, Division of Endocrinology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
⁴ Department of Pediatrics, Division of Endocrinology, the IWK Hospital, Dalhousie University, Nova Scotia, Halifax, Canada

OBJECTIVE—To investigate trends and geographic variation in diabetic ketoacidosis (DKA) hospitalization rates among children in Ontario from 1991 to 1999.

RESEARCH DESIGN AND METHODS—Canadian Institute for Health Information (CIHI) data were used to identify 15,872 diabetes-related hospital admissions in children younger than 19 years in Ontario from 1991 to 1999. Of these, 5,008 admissions were because of DKA and 10,864 admissions were because of conditions other than DKA (non-DKA). Small area variation analysis was used to compare areas with high versus low DKA admission rates.

RESULTS—There was a 19% relative decrease in the overall diabetes admission rate over the study period. Non-DKA admissions decreased by 29%, whereas DKA admissions remained stable. Total days of care decreased by 393 days per year for non-DKA admissions and by 99 days per year for DKA admissions. The average length of hospital stay decreased from 4.9 to 3.5 days for non-DKA admissions and from 4.5 to 3.2 days for DKA admissions. The fatality rate was 0.19% for non-DKA admissions and 0.18% for DKA admissions. Variation across geographic areas remained stable for DKA over the study period (Kendall’s correlation coefficient 0.64, P = 0.017) with an average 3.7-fold difference between the lowest and highest regions.

CONCLUSIONS—Increased ambulatory care efforts for children with type 1 diabetes in Ontario have successfully reduced non-DKA admission rates. However, DKA admission rates have remained stable. Geographic variation for DKA admissions is low, but the observed 3.7-fold difference is clinically important for a preventable complication with a significant potential for long-term morbidity and mortality. Prevention strategies are needed, particularly in areas identified with the highest rates.

Abbreviations: CF, case fatality • CIHI, Canadian Institute for Health Information • DHC, District Health Council • DKA, diabetic ketoacidosis • ICD-9, International Classification of Diseases, 9th Revision • ICES, Institute for Clinical Evaluative Sciences

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				A. Rewers, G. Klingensmith, C. Davis, D. B. Petitti, C. Pihoker, B. Rodriguez, I. D. Schwartz, G. Imperatore, D. Williams, L. M. Dolan, et al. Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study Pediatrics, May 1, 2008; 121(5): e1258 - e1266. [Abstract] [Full Text] [PDF]

				A. Hekkala, M. Knip, and R. Veijola Ketoacidosis at Diagnosis of Type 1 Diabetes in Children in Northern Finland: Temporal changes over 20 years Diabetes Care, April 1, 2007; 30(4): 861 - 866. [Abstract] [Full Text] [PDF]

				A. Smaldone, J. Honig, P. W. Stone, R. Arons, and K. Weinger Characteristics of California Children With Single Versus Multiple Diabetic Ketoacidosis Hospitalizations (1998-2000) Diabetes Care, August 1, 2005; 28(8): 2082 - 2084. [Full Text] [PDF]

				G. L. Booth, J. E. Hux, J. Fang, and B. T.B. Chan Time Trends and Geographic Disparities in Acute Complications of Diabetes in Ontario, Canada Diabetes Care, May 1, 2005; 28(5): 1045 - 1050. [Abstract] [Full Text] [PDF]

				J. Silverstein, G. Klingensmith, K. Copeland, L. Plotnick, F. Kaufman, L. Laffel, L. Deeb, M. Grey, B. Anderson, L. A. Holzmeister, et al. Care of Children and Adolescents With Type 1 Diabetes: A statement of the American Diabetes Association Diabetes Care, January 1, 2005; 28(1): 186 - 212. [Full Text] [PDF]

				D B Dunger, M A Sperling, C L Acerini, D J Bohn, D Daneman, T P A Danne, N S Glaser, R Hanas, R L Hintz, L L Levitsky, et al. ESPE/LWPES consensus statement on diabetic ketoacidosis in children and adolescents Arch. Dis. Child., February 1, 2004; 89(2): 188 - 194. [Abstract] [Full Text]

				D. B. Dunger, M. A. Sperling, C. L. Acerini, D. J. Bohn, D. Daneman, T. P.A. Danne, N. S. Glaser, R. Hanas, R. L. Hintz, L. L. Levitsky, et al. European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society Consensus Statement on Diabetic Ketoacidosis in Children and Adolescents Pediatrics, February 1, 2004; 113(2): e133 - 140. [Full Text] [PDF]