Predictors of Short Intensive Care Unit Stay for Patients with Diabetic Ketoacidosis Using a Novel Emergency Department-Based Resuscitation and Critical Care Unit.

Autor: Zhou VL; School of Medicine and Dentistry, University of Rochester, Rochester, New York., Shofer FS; Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania., Desai NG; Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania., Lorincz IS; Department of Endocrinology, Diabetes, and Metabolism, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania., Mull NK; Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania., Adler DH; Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York., Greenwood JC; Department of Emergency Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2019 Feb; Vol. 56 (2), pp. 127-134. Date of Electronic Publication: 2018 Nov 03.
DOI: 10.1016/j.jemermed.2018.09.048
Abstrakt: Background: The resuscitation and critical care unit is a novel emergency department-intensive care unit designed to provide early critical care to emergency department patients for ≤24 h.
Objectives: This study sought to identify clinical variables associated with short intensive care unit (ICU) stays in patients with diabetic ketoacidosis (DKA), who commonly require ICU-level care.
Methods: We conducted a retrospective, single-center, cross-sectional study of DKA patients ≥18 years of age who presented to an academic, urban hospital emergency department over 16 months. Patient demographics and clinical variables extracted from medical records were compared between prolonged ICU stay patients of ≥24 h versus short ICU stay patients (SSPs) of <24 h. ICU care was defined as treatment in the resuscitation and critical care unit or inpatient ICU.
Results: One hundred sixty-eight emergency department visits with a primary diagnosis of DKA were analyzed. There were 53 prolonged ICU stay patients, 58 SSPs, and 57 patients required no ICU time. SSPs had significantly higher initial serum bicarbonate (13.0 vs. 9.0 mEq/L, p = 0.01) and shorter anion gap closure time (9.8 vs. 14.4 hours, p = 0.003). Medication nonadherence was a significantly more frequent precipitant in SSPs (67.2% vs. 47.2%, p = 0.03). Initial anion gap, glucose, beta-hydroxybutyrate, and severity of illness scores were not significantly different between groups. After multivariate logistic regression adjusting for variables significant from univariate analysis, higher initial bicarbonate (p = 0.04) and medication nonadherence (p = 0.03) remained significantly associated with SSPs.
Conclusions: Patients with DKA with short ICU stays have higher initial bicarbonate levels and are more likely to have medication nonadherence than patients requiring prolonged critical care. These variables may identify patients with DKA who are best treated in an emergency department-intensive care unit to potentially reduce inpatient ICU use.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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