27 - The Association between the COVID-19 Pandemic, Intensive Care Unit Admissions, and Utilization of Intensive Care Unit therapies in Children with Hyperglycemic Crisis

Poster Number: 27
Publication Number: 27.201

Vanessa R. Toomey, CHLA, La Crescenta, CA, United States; Margaret J. Klein, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jose A. Pineda, Children's Hospital Los Angeles, Los Angeles, CA, United States; Alaina P. Vidmar, Children's Hospital Los Angeles, Los Angeles, CA, United States; Anoopindar Bhalla, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States

Background: The frequency of children admitted to the intensive care unit (ICU) with diabetic ketoacidosis increased during the COVID-19 pandemic. However, it is not known whether the pandemic has also been associated with increased ICU admissions or ICU therapies for children diagnosed with hyperglycemic crisis.

Objective: The primary objective was to evaluate the association between the COVID-19 pandemic and admission to the ICU for hyperglycemic crisis. Secondary objectives included characterizing the incidence of hyperglycemic crisis admissions and evaluating secondary outcomes of length of stay (LOS), mortality, therapies, and cost.

Design/Methods: We performed a retrospective study of children ≤ 18 years old hospitalized from 3/2017 to 3/2021 in 37 US pediatric hospitals in the Pediatric Health Information System for hyperglycemic crisis (defined as diabetic ketoacidosis, hyperglycemic hyperosmolar syndrome, hyperosmolar ketoacidosis). A three-year period defined the pre-COVID-19 years (3/2017-3/2020) and the COVID-19 period was defined as 3/2020-3/2021. The primary outcome was admission to the pediatric ICU. Secondary outcomes included LOS > 3 days, mortality, use of invasive mechanical ventilation and ICU therapies for neurologic compromise (head imaging, hyperosmolar therapy, or antiepileptic therapy), and cost.

Results: In multivariable analysis, the COVID-19 pandemic was associated with an increase in ICU admissions for hyperglycemic crisis (OR 1.37, CI 1.24 – 1.52, p< 0.001). There was an association between the COVID-19 pandemic and longer LOS in the ICU (LOS >3 days: OR 1.27, CI: 1.10-1.46 p=0.0013), but not between the pandemic and increased mortality (OR 0.83, CI:0.51-1.33, p=0.43). Use of mechanical ventilation (OR 1.25, CI 1.01-1.54, p=0.044) was higher during the COVID-19 pandemic. Utilization of ICU therapies for neurologic compromise was also higher but not statistically significant (OR 1.14, 0.99-1.31, p=0.07).  Furthermore, the cost for admission (floor and ICU) was 36% higher during the COVID-19 pandemic (IRR 1.36, 1.11-1.23, p< 0.0001). All models controlled for age, gender, region, payer, race/ethnicity, and center-level effects. 
 Conclusion(s): During the COVID-19 pandemic, children with hyperglycemic crisis were admitted with a higher acuity of illness demonstrated by increased ICU admissions, longer LOS, higher utilization of mechanical ventilation, and greater financial impact on the healthcare system.
Figure 1. a. Trends for pediatric admissions to the floor and PICU. b. Trends for pediatric hyperglycemic crisis admissions to the floor and PICU.
Table 1: Univariate analysis to assess for independent association between patient demographics and admission for hyperglycemic crisis before and during the COVID-19 pandemic.