National Study of U.S. Emergency Department Visits With Diabetic Ketoacidosis, 1993–2003

Patients with diabetic ketoacidosis (DKA) are often managed in the emergency department before hospital admission. DKA hospitalizations comprise a significant portion of health care costs for diabetes (1). Although mortality for DKA has fallen, it remains an important cause of diabetes-associated death, especially among younger patients with diabetes (2). Prior analyses of DKA have been single-center intensive care unit (ICU) studies or based on hospital discharges (3–5). Patients may, however, be treated in the emergency department and then admitted to a non-ICU setting or discharged; the frequency of these practices is not known. We sought to describe the epidemiology of emergency department visits with DKA. We analyzed the emergency department component of the 1993–2003 U.S. National Hospital Ambulatory Medical Care Survey (NHAMCS). Our institutional review board waived review of this analysis. Methodological details are described elsewhere (6–8). Briefly, NHAMCS uses a four-stage sampling strategy covering geographic primary sampling units, hospitals within primary sampling units, emergency departments within hospitals, and patients within emergency departments. Hospitals were stratified by region, presence of emergency department, ownership type, and size. Within each stratum, hospitals were selected with a probability proportional to the number of emergency department visits. Data were collected during randomly …