PURPOSE: Diabetic Ketoacidosis (DKA) is a common diagnosis for admission in medical ICUs. Despite the frequency with which we see these cases, no studies have been published in the recent past that demonstrates the need for an ICU bed for all cases of DKA. Using a severity of illness scoring system (SIS), we attempt to evaluate appropriateness of admissions to the ICU for patients in DKA.
METHODS: Randomly selected records of 30 patients admitted with the primary diagnosis of DKA from January to June of 2004 were reviewed retrospectively. The appropriateness of admission to the ICU was determined using the Apache II score and a modified five point (0-IV) SIS for DKA.
RESULTS: Of all the patients in this study, 84% were admitted to the ICU; however, only 33% were categorized as Grades III and IV, which is associated with a higher mortality, and met criteria for admission for intensive care management. Where 67% could have been appropriately treated on the regular ward, only 16% of all patients were managed outside of the ICU. The mean length of stay in the ICU for those in Grades 0-II were 1.14 days compared with 9.2 days for those of Grades III-IV. Hospital stay for those in Grades 0-II were also significantly different compared to those in Grades III-IV (5.93 and 10.58 days respectively, p<0.05).
CONCLUSION: In our study, we can conclude that 51% of the admissions to the ICU due to DKA could have been properly managed in the regular ward. At an average cost of $12,650 for each ICU admission versus $6,804 in a step down unit, a significant savings of more than 50% can be obtained without sacrificing patient care; an important consideration in an era where hospitals are operating to achieve or maintain economic solvency.
CLINICAL IMPLICATIONS: The use of a Severity of Illness scoring system for admission to the ICU of patients in DKA can have a significant resource utilization and economic impact.
DISCLOSURE: Jay Nfonoyim, None.