The dawdle, dally and delay of diabetic ketoacidosis: Decoding the emergency department length of stay – A chart review

Abstract

Background: Diabetic ketoacidosis is a life-threatening complication requiring prompt intervention. Understanding factors influencing the duration of emergency department (ED) stay is essential for optimising patient care and resource utilisation.

Methods: A retrospective review was conducted on patients diagnosed with diabetic ketoacidosis at a regional hospital in KwaZulu-Natal between March 2022 and March 2023. Demographics, precipitants, severity, potassium levels and time to resolution were analysed to determine correlations between these variables and the duration of stay in the ED.

Results: Of the 156 records, 105 met the inclusion criteria. The mean age was 36.8 years, with 51.4% male and 98.1% of black ethnicity. Poor compliance (37.1%) and infection (31.4%) were the commonest precipitants. Longer durations in the ED (16.2 h, p = 0.007) were linked to cases with unknown precipitants. The median stay was 6 h–12 h, with infection linked to the longest mean duration (10.1 h). Recurrent episodes occurred in 38.1% of patients. Severe diabetic ketoacidosis (13.0 hours, p = 0.001) and a lower pH at presentation (β = –19.6, p < 0.001) were significantly associated with prolonged time to resolution. Potassium abnormalities (29.5%) had no significant effect on duration of stay (p = 0.775).

Conclusion: Unknown precipitants significantly influenced the length of stay in the ED. Infection, severe acidosis, and hypokalaemia contributed with variable significance, highlighting that targeted interventions may potentially reduce congestion in these settings.

Contribution: This study provides valuable insights into factors influencing ED length of stay for diabetic ketoacidosis patients, offering evidence to improve clinical management and resource allocation in regional hospitals.