Impact of Early Emergency Department Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State on ICU Admission and In-Hospital Mortality: A Retrospective Cohort Study

Abstract

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are life-threatening endocrine emergencies frequently encountered in emergency departments (EDs). Delayed recognition and treatment are associated with increased intensive care unit (ICU) admission and mortality [1,2]. To evaluate the impact of early recognition and ED-based management of DKA and HHS on ICU admission and in-hospital mortality. A retrospective cohort study was conducted among adult patients presenting to the ED with confirmed DKA or HHS. Data included time to diagnosis, time to initiation of insulin and intravenous fluids, electrolyte abnormalities, ICU admission, and in-hospital mortality. Early management was defined as diagnosis within ≤60 minutes and initiation of insulin and IV fluids within ≤90 minutes of ED arrival. Logistic regression analysis was used to identify independent predictors of ICU admission and mortality. Among 100 patients, early management was associated with significantly lower ICU admission (24.1% vs. 47.6%, p = 0.01) and mortality (5.2% vs. 14.3%, p = 0.04). Delayed management independently predicted ICU admission (OR 2.82, 95% CI 1.22–6.51) and in-hospital mortality (OR 3.12, 95% CI 1.01–9.65). Patients with HHS had higher ICU admission and mortality compared with those with DKA. Early recognition and timely ED management of DKA and HHS significantly improve clinical outcomes. Implementation of standardized ED protocols may reduce avoidable ICU admissions and in-hospital mortality, particularly in resource-limited settings.