title: Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA.
abstract: BACKGROUND
  Previous studies of hyperglycemic hyperosmolar syndrome (HHS) in children are limited to case series or single-institution reviews, which describe HHS primarily in children with type 2 diabetes mellitus.
  
  
  OBJECTIVE
  To estimate the incidence and describe the epidemiologic characteristics of HHS among children in USA.
  
  
  METHODS
  All discharges in the Kids' Inpatient Database - a triennial, nationwide, stratified probability sample of hospital discharges for years 1997-2009 - with age 0-18 yr and a diagnosis of HHS.
  
  
  METHODS
  Using sample weights, we calculated the incidence and population rate of hospitalization with a diagnosis of HHS.
  
  
  RESULTS
  Our sample included 1074 HHS hospitalizations; of these, 42.9% were 16-18 yr, 70.6% had type 1 diabetes (T1D), and 53.0% had major or extreme severity of illness. The median length of stay was 2.6 d, 2.7% of hospitalizations ended in death, and median hospital charge was $10 882. When comparing HHS hospitalizations by diabetes type, the proportion with T1D fell steadily with age, from 89.1% among children 0-9 yr, to 65.1% in 16-18 yr olds. Patients with T1D had a shorter length of stay by 0.9 d, and had a lower median charge by $5311. There was no difference in mortality by diabetes type. Population rates for HHS hospitalization rose 52.4% from 2.1 to 3.2 per 1 000 000 children from 1997 to 2009.
  
  
  CONCLUSIONS
  Hospitalizations for a diagnosis of HHS have high morbidity and are increasing in incidence since 1997. In contrast to prior reports, we found a substantial percentage of HHS hospitalizations occurred among children with T1D.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, Division of Pediatric Critical Care Medicine, Baltimore, MD 21201, USA. dbagdure@peds.umaryland.edu
authors.forename: Dayanand
authors.initials: D
authors.lastname: Bagdure
authors.forename: Arleta
authors.initials: A
authors.lastname: Rewers
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Campagna
authors.forename: Marion R
authors.initials: MR
authors.lastname: Sills
mesh_terms: D000293:Adolescent; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013577:Syndrome; D014481:United States / Q000453:epidemiology