Epidemiology of hyperglycemic hyperosmolar syndrome in children hospitalized in USA

Authors

  • Dayanand Bagdure,

    Corresponding author
    • Department of Pediatrics, University of Maryland School of Medicine, Division of Pediatric Critical Care Medicine, Baltimore, MD, USA
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  • Arleta Rewers,

    1. Department of Pediatrics, University of Colorado School of Medicine, Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA
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  • Elizabeth Campagna,

    1. Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO, USA
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  • Marion R Sills

    1. Department of Pediatrics, University of Colorado School of Medicine, Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO, USA
    2. Children's Outcome Research Program, University of Colorado School of Medicine, Aurora, CO, USA
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Corresponding author:

Dayanand Bagdure, MD, MPH,

Department of Pediatrics,

University of Maryland School of Medicine,

Division of Pediatric Critical Care Medicine,

29 South Greene Street, Suite 104,

Baltimore, MD 21201,

USA.

Tel: 410-328-6957;

fax: 410-328-0680;

E-mail: dbagdure@peds.umaryland.edu

Abstract

Background

Previous studies of hyperglycemic hyperosmolar syndrome (HHS) in children are limited to case series or single-institution reviews, which describe HHS primarily in children with type 2 diabetes mellitus.

Objective

To estimate the incidence and describe the epidemiologic characteristics of HHS among children in USA.

Subjects

All discharges in the Kids' Inpatient Database – a triennial, nationwide, stratified probability sample of hospital discharges for years 1997–2009 – with age 0–18 yr and a diagnosis of HHS.

Methods

Using sample weights, we calculated the incidence and population rate of hospitalization with a diagnosis of HHS.

Results

Our sample included 1074 HHS hospitalizations; of these, 42.9% were 16–18 yr, 70.6% had type 1 diabetes (T1D), and 53.0% had major or extreme severity of illness. The median length of stay was 2.6 d, 2.7% of hospitalizations ended in death, and median hospital charge was $10 882. When comparing HHS hospitalizations by diabetes type, the proportion with T1D fell steadily with age, from 89.1% among children 0–9 yr, to 65.1% in 16–18 yr olds. Patients with T1D had a shorter length of stay by 0.9 d, and had a lower median charge by $5311. There was no difference in mortality by diabetes type. Population rates for HHS hospitalization rose 52.4% from 2.1 to 3.2 per 1 000 000 children from 1997 to 2009.

Conclusion

Hospitalizations for a diagnosis of HHS have high morbidity and are increasing in incidence since 1997. In contrast to prior reports, we found a substantial percentage of HHS hospitalizations occurred among children with T1D.

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