Pediatria Clínica: Acesso Aberto
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Children with Diabetic Ketoacidosis in Western Sydney: Too Close or Too Far?

Yi Hern Lee, Stephen Sze Shing Teo, Tien-Ming Hng,

Aim: To analyse the presentations of paediatric Diabetic Ketoacidosis (DKA) to black town and mount druitt hospitals over a 10-year period to assess the associated travel burden incurred to receive care from the closest tertiary referral centre for their families to receive care from the closest tertiary referral center, we gain insights into the accessibility and utilization of healthcare services, particularly for conditions as critical as DKA in pediatric patients. The analysis involves delving into various aspects, including the frequency and severity of DKA presentations, demographic characteristics of the affected population and the geographical distribution of patients seeking care at these hospitals. By examining trends over a decade, patterns may emerge that shed light on potential factors influencing DKA incidence and management in these communities. Furthermore, evaluating the travel burden faced by families adds another layer of understanding to the healthcare landscape. Factors such as distance to the tertiary referral center, transportation options available, socioeconomic status of families and potential barriers to accessing care may all play a role in determining the extent of this burden. This analysis could uncover disparities in healthcare access and inform strategies to mitigate them, ensuring equitable access to quality care for all pediatric patients, irrespective of their geographical location or socioeconomic background. Moreover, exploring the impact of travel burden on health outcomes, such as delays in seeking treatment, exacerbation of DKA symptoms and complications arising from suboptimal management, provides valuable insights for healthcare policymakers and providers. By identifying areas for improvement in the healthcare system, such as enhancing transportation infrastructure, expanding telehealth services or implementing community outreach programs, we can work towards reducing the burden on families and improving the overall management of pediatric DKA. Methods: Retrospective review of data on all patients ≤ 16 years who presented with DKA to black town and mount druitt hospitals between 2008 and 2017. Results: Of the 79 DKA presentations including 53 first presentations, the mean age was 12 years. Fifty-two percent of patients presented with moderate or severe DKA and 63.3% (50 patients) were acutely transferred for further expert management. The mean difference travel distance for patients from their usual residence to the Children’s Hospital at Westmead (CHW) compared to or Black Town Hospital (BH) and Mount Druitt Hospital (MDH) was eight and 16 kilometres respectively, translating to an additional 15 and 36 minutes respectively by public transport. Conclusions: Establishing local paediatric diabetes services to improve access to care may overcome the challenge of distance. This can facilitate follow up in the long-term and potentially reduce the number of hospital presentations with DKA. Moreover, the availability of local services may empower primary care providers to manage diabetes more effectively, thus reducing the reliance on tertiary care centers for acute management and potentially decreasing the number of hospital presentations with DKA. In addition to improving access to care, local pediatric diabetes services can foster a sense of community and support among families facing similar challenges. This can be particularly beneficial for parents/caregivers in navigating the complexities of managing a chronic condition like diabetes in their children. Overall, investing in local pediatric diabetes services has the potential to enhance the quality of care, reduce healthcare disparities and ultimately improve outcomes for children with diabetes in underserved areas.