title: Patient Characteristics Associated with Differences in Admission Frequency for Diabetic Ketoacidosis in United States Children's Hospitals.
abstract: OBJECTIVE
  To determine across and within hospital differences in the predictors of 365-day admission frequency for diabetic ketoacidosis (DKA) in children at US children's hospitals.
  
  
  METHODS
  Multicenter retrospective cohort analysis of 12,449 children 2-18 years of age with a diagnosis of DKA in 42 US children's hospitals between 2004 and 2012. The main outcome of interest was the maximum number of DKA admissions experienced by each child within any 365-day interval during a 5-year follow-up period. The association between patient characteristics and the maximum number of DKA admissions within a 365-day interval was examined across and within hospitals.
  
  
  RESULTS
  In the sample, 28.3% of patients admitted for DKA experienced at least 1 additional DKA admission within the following 365 days. Across hospitals, patient characteristics associated with increasing DKA admission frequency were public insurance (OR 1.97, 95% CI 1.71-2.26), non-Hispanic black race (OR 2.40, 95% CI 2.02-2.85), age ≥ 12 (OR 1.98, 95% CI 1.7-2.32), female sex (OR 1.41, 95% CI 1.29-1.55), and mental health comorbidity (OR 1.36, 95% CI 1.13-1.62). Within hospitals, non-Hispanic black race was associated with higher odds of 365-day admission in 59% of hospitals, and public insurance was associated with higher odds in 56% of hospitals. Older age, female sex, and mental health comorbidity were associated with higher odds of 365-day admission in 42%, 29%, and 15% of hospitals, respectively.
  
  
  CONCLUSIONS
  Across children's hospitals, certain patient characteristics are associated with more frequent DKA admissions. However, these factors are not associated with increased DKA admission frequency for all hospitals.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA. Electronic address: faisal.malik@seattlechildrens.org.
authors.forename: Faisal S
authors.initials: FS
authors.lastname: Malik
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.affiliation: Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Ron
authors.initials: R
authors.lastname: Keren
authors.affiliation: Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.affiliation: Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, UT.
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
authors.affiliation: Section of Pediatric Hospital Medicine, Children's Hospital, Colorado, Aurora, CO.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wilson
authors.affiliation: Division of Inpatient Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, WA.
authors.forename: Joel S
authors.initials: JS
authors.lastname: Tieder
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016883:Diabetic Ketoacidosis / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States