O3307: Outcomes in Fluid Resuscitation Alone Versus Fluids with Insulin During Transport of Pediatric DKA Patients: A Retrospective Chart Review

Background: DKA is a life-threatening complication of diabetes mellitus and can be classified as mild, moderate, or severe. Although inpatient management has evolved, protocols for transporting DKA patients to a tertiary care center (TCC) from an outside hospital (OSH) vary. This can cause unnecessary healthcare spending, such as using rotor wing—with costs exceeding $40,000—instead of ground transport—with costs approximating $2,500. Additionally, there are increased risks for adverse events, which can cause a longer length of stay (LOS), create more complications, and cause patients to require a higher level of care. For example, in certain states, paramedics cannot administer or titrate insulin drips without being a critical care paramedic, potentially causing hypoglycemia. Currently, International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines dictate that insulin should be given at least one hour after initiation of fluid resuscitation. Therefore, we have two aims. First, we observed two treatment groups of pediatric DKA patients transported from an OSH to Le Bonheur Children’s Hospital (LBCH): ones who received fluids alone and ones who received fluids and insulin. We hypothesize they will have similar outcomes in LOS and rates of ICU admissions and cerebral edema (CE) development. Second, we hypothesize no statistically significant difference exists between those transported via rotor wing or ground, regardless of DKA severity and treatment group.

Methods: We conducted a retrospective chart review of pediatric patients transported via rotor wing or ground from an OSH to LBCH with mild, moderate, and severe DKA from January 1st, 2011, to January 1st, 2021. We then used Pearson's chi-square, Fisher's exact test, and Kruskal-Wallis rank sum tests to assess if there was a significant difference for each variable across each group. The statistical significance was determined with two-sided p< 0.05. Our primary endpoint was LOS at LBCH. Our secondary endpoints were transport method, rates of CE development, and admission to either the ICU or the floor.

Results: 238 pediatric patients 0-18 years of age were included in this study. Patients given fluids alone during transport had no statistically significant differences in length of stay and rates of ICU admissions and CE development compared to those transported with fluids and insulin. This was found when controlling for males and females in mild, moderate, or severe DKA. This finding was similar when looking at transport methods.

Conclusion: Regardless of DKA severity, transportation with fluids alone has similar outcomes in length of stay and rates of ICU admissions and CE development as those transported with insulin and fluids. Additionally, despite theoretically arriving sooner, rotor wing transport has no improvement in patient outcomes compared to ground transport. Using only fluids with ground transport reduces the costs to patients and the healthcare system.