• Shannon M Fernando, Sean M Bagshaw, Bram Rochwerg, Daniel I McIsaac, Kednapa Thavorn, Alan J Forster, Alexandre Tran, Peter M Reardon, Erin Rosenberg, Peter Tanuseputro, and Kwadwo Kyeremanteng.
• Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. Electronic address: sfernando@qmed.ca.
• J Crit Care. 2019 Apr 1; 50: 257-261.

PurposeThere is wide variation in the utilization of Intensive Care Unit (ICU) beds for treatment and monitoring of adult patients with Diabetic Ketoacidosis (DKA). We sought to compare the outcomes and hospital costs of adult DKA patients admitted to ICUs as compared to those admitted to step-down units.Materials And MethodsWe included consecutive adult patients from two hospitals with a diagnosis of DKA. Patients were either admitted to the ICU, or a step-down unit, which has a nurse-to-patient ratio of 2:1, but does not have capability for mechanical ventilation or administration of vasoactive agents. The primary outcome was in-hospital mortality.ResultsWe included 872 patients in the analysis. 71 (8.1%) were admitted to ICU, while 801 (91.9%) were admitted to a step-down unit. We found no difference in in-hospital mortality between patients admitted to the ICU and those admitted to the step-down unit (adjusted odds ratio [OR]: 1.14, 95% confidence interval [CI]: 0.87-2.64). Mean total hospital costs were significantly higher for patients admitted to the ICU ($20,428 vs. $6484, P < 0.001).ConclusionsAdult DKA patients admitted to a step-down unit had comparable in-hospital mortality and lower hospital costs as compared to those admitted to the ICU.Copyright © 2018 Elsevier Inc. All rights reserved.

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