The impact of pediatric intensivists on the management of severe pediatric diabetic ketoacidosis in pediatric intensive care units

Abstract

Introduction The impact of pediatric intensivists on the management of pediatric patients with diabetic ketoacidosis (DKA) remains unknown. This study aimed to evaluate the impact of pediatric intensivists on outcomes in pediatric intensive care units (PICUs). Methods This was a two-institution retrospective study of patients with DKA admitted to the PICU between 2012 and 2023. Pediatric patients (< 19 years of age) were included if they met the criteria for severe DKA on PICU admission. The patients were subsequently divided into two groups based on the presence or absence of a pediatric intensivist. The primary outcome was the PICU length of stay (LOS). Secondary outcomes were adverse effects during DKA treatment, hospital LOS, time to DKA resolution, and mortality. Results Thirty-two patients admitted to the PICU with a median age of 11.50 years (range 0–18 years) were included; 18 (56.3%) were female. Patients managed by pediatric intensivists had significantly shorter PICU LOS (2.40 vs. 4.87 days, p < 0.05). Neither group had a significant difference in time to DKA resolution or in hospital LOS. However, adverse effects during DKA treatment were significantly decreased in the high-intensity group compared to the low-intensity group (7.7% vs. 52.6%, p < 0.05). Conclusions Management of DKA patients by pediatric intensivists can reduce the PICU LOS with significant improvement in DKA treatment complications.