Increased Use of Hyperosmolar Therapy for Suspected Clinically Apparent Brain Injury in Pediatric Patients with Diabetic Ketoacidosis during the Peak of the COVID-19 Pandemic

Table 3

Comparison of clinical characteristics of patients presenting with suspected clinically apparent brain injury (CABI) before the COVID-19 pandemic, patients presenting with suspected CABI during the pandemic, and cases presenting with diabetic ketoacidosis but without suspected CABI during the pandemic.

Characteristics	Group			Test statistic	value
	Suspected CABI before pandemic (group 1, n = 18)	Suspected CABI during pandemic (group 2,  n = 18)	DKA without suspected CABI during pandemic (group 3, n = 141)
Clinical variables (mean ± SD^†or proportion)
New diagnosis of diabetes	83%	83%	62%	χ ^2 = 5.989	0.05
Transferred from referring hospital	78%	72%	42%	χ ^2 = 12.732	0.002
Initial GCS	13.3 ± 2.6	12.4 ± 3.6	14.9 ± 0.4	H = 34.489	<0.001
Lowest GCS	9.9 ± 3.7	10.1 ± 3.4	14.6 ± 1.0	H = 90.141	<0.001
Length of stay (days)^‡	5.0 ± 2.8	4.4 ± 3.4	2.5 ± 1.4	H = 34.698	<0.001
Suspected or documented infection	33%	11%	9%	FHH exact test = 7.964	0.014
Rate of neuroradiological imaging	28%	17%	N/A	Fisher’s exact test = 0.643	0.691
Time to suspected CABI development (mins)^§	219 ± 168	140 ± 80	N/A	U = 123	0.23
Duration of treatment (mins)^¶	308 ± 229	249 ± 239	N/A	U = 159	0.91
Number of interventions				Fisher’s exact test = 0.190	0.91
1	56%	61%	N/A
2	22%	17%	N/A
3+	22%	22%	N/A

^†Although means and standard deviations were reported for all variables, nonparametric testing was performed for comparison of mean ranks in the cases where data in at least one group were not normally distributed and and/or there were unequal variances across the groups. ^‡Two patients in group 3 who had lengths of stay of 123.9 and 63.1 days due to social issues or medical complexities unrelated to their diabetes diagnosis, respectively, were excluded from the analysis. ^§Calculated as the time of presentation subtracted from the time of the first hyperosmolar therapy administration (in mins). ^¶Calculated as the time difference between the first and last hyperosmolar treatment (in mins). On posthoc analysis, group 3 was significantly different from groups 1 and 2. On posthoc analysis, group 1 was significantly different from groups 2 and 3. CABI, clinically apparent brain injury; DKA, diabetic ketoacidosis; SD, standard deviation; FHH, Fisher-Freeman-Halton; GCS, Glasgow coma scale; N/A, not applicable.