Characteristics, Prehospital Management, and Outcomes in Patients Assessed for Hypoglycemia: Repeat Access to Prehospital or Emergency Care

Sinclair, Julie E; Austin, Mike; Froats, Mark; Leduc, Shannon; Maloney, Justin; Dionne, Richard; Reed, Andy; Vaillancourt, Christian

doi:10.1080/10903127.2018.1504150

Cited by 14 publications

(39 citation statements)

References 22 publications

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“…Our analysis illustrates similar locations for hypoglycaemic events in the present literature [ 8 ] but different peak hours: 06:00–11:59 and 12:00–17:59. These peak hours are not in line with the predicted morning elevation of blood glucose level, i.e., the “dawn phenomenon” [ 16 , 17 ].…”

Section: Discussionsupporting

confidence: 77%

“…We also identified intramuscular glucagon as the most frequently used agent during on-scene management to reverse severe hypoglycaemia in Kuwait. This is different from North American EMS systems, where parenteral glucose is widely used to reverse severe hypoglycaemia [ 6 , 8 ]. One reason for this discrepancy is that the majority of the local EMS staff are EMTs, and parenteral glucose administration is not within the scope of EMT practice [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there have been a limited number of studies on severe hypoglycaemia in the prehospital setting [ 7 , 8 ]. The goal of this study is to establish severe hypoglycaemia characteristics, complications and outcomes with the aim to deliver groundwork to revise the current severe hypoglycaemia guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

et al. 2021

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Background The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. Method This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10–30 min and normal random blood glucose (RBS) within 10–30 min. Results A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10–30 min (P = .05) and normal RBS within 10–30 min (P = .006). Conclusion: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

et al. 2021

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“…These comprised 1 HTA 21 (that included a systematic review, a randomized controlled trial [RCT], and an economic evaluation) and 2 non-randomized studies. 22,23 Appendix 1 presents the PRISMA 24 flow chart of the study selection. Additional references of potential interest are provided in Appendix 5.…”

Section: Quantity Of Research Availablementioning

confidence: 99%

Treat and Release for Patients Requiring Emergency Medical Services

Young¹,

Horton²

2021

cjht

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“Treat and release” and “treat and refer” protocols or practices refer to the onsite treatment of patients by responding emergency medical services personnel that does not involve transporting patients to health care facilities for additional assessment and treatment. The goal of these protocols is to allow patients to be released from care or to be referred directly to non-emergency services by emergency medical services personnel when appropriate, diverting patients from emergency departments. One health technology assessment that included a relevant randomized controlled trial and economic evaluation and 2 non-randomized studies were identified for inclusion. These studies examined treat and release or treat and refer protocols for treating hypoglycemia and exertional heat stroke, and for attending to older people following a fall. Overall, the clinical evidence summarized in this report suggests that treat and release protocols are as good as, or better than, usual care (i.e., onsite treatment of immediate medical care followed by transportation to health care facilities). Across most reported outcomes, there were no significant differences between patients who received care using treat and release or treat and refer protocols, and those who received usual care; however, there were some instances where the use of these protocols was associated with improvements in some clinical outcomes, such as patient satisfaction, risk for future falls or fractures, and some measures of repeat access to health care services. Findings related to the cost-effectiveness of treat and refer protocols were inconclusive because of the limited generalizability of the findings from the included economic evaluation. The economic evaluation estimated that implementing a treat and refer protocol for older patients who experienced a fall did not result in significant changes to health care resource utilization and did not generate improved health-related quality of life compared to usual care. No evidence-based guidelines regarding the use of treat and release protocols for patients requiring emergency medical services were identified.

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“…Although past medical history of diabetes mellitus and neurological examination ndings provide useful clinical information to determine whether hypoglycaemia is a potential cause of AMS [1,4,5], it is often di cult to obtain a detailed medical history and perform physical examination on the eld, especially for patients with AMS. Therefore, ndings of any simple, routine physical examination, such as vital signs, can be used to safely exclude patients with AMS who do not need BG measurement.…”

Section: Introductionmentioning

confidence: 99%

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Mizu

Matsuoka

Huh

et al. 2020

Preprint

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BackgroundBlood glucose (BG) measurement by paramedics for patients with altered mental status is recommended as pre-hospital care in Japan. Therefore, paramedics prioritise BG measurement over transport to hospital even in emergency conditions such as hypotension or hypoxaemia. The purpose of this study was to examine the relationship between BG levels and vital signs, and to evaluate whether vital signs are effective in determining the necessity of BG measurement in pre-hospital settings. MethodsWe extracted data of patients who had BG measurements performed by paramedics in Kobe City from April 2015 to March 2019. We retrospectively investigated patient age, sex, presence of hypoglycaemia (BG level < 50 mg/dL) and vital signs. If a patient did not have hypoglycaemia and was transported to the Kobe City Medical Centre General Hospital, a final diagnosis was obtained. Patients aged below 15 years, and those with BG measurement errors, missing vital sign data, or a Japan Coma Scale 0 and I-digit codes were excluded. The χ2 test and Mann-Whitney U test were used for statistical analysis, and P<0.05 was considered statistically significant. ResultsOf the 1,791 patients, 1,242 were eligible for analysis (mean age, 71.9 years; 805 [58%] male). Hypoglycaemia was observed in 324 patients (26.1%). Of the 918 non-hypoglycaemic patients, 253 (27.6%) were transported to our hospital and stroke was the most common final diagnosis (61 patients [24.1%]). The non-hypoglycaemic group had more elderly patients than the hypoglycaemic group (median 73 vs. 76 years; P < 0.01). A significant difference in each vital sign were noted between hypoglycaemic and non-hypoglycaemic groups, with body temperature showing the highest difference between groups (area under the curve, 0.71; 95% confidence interval [CI], 0.68-0.74). Furthermore, in cases with systolic blood pressure being over 100 mmHg and body temperature being 38°C or less, it was highly unlikely that hypoglycaemia caused impaired consciousness (likelihood ratio 0.12 and 0.16; 95% CI 0.05-0.25 and 0.06-0.35, respectively). ConclusionWhen considering pre-hospital hypoglycaemia assessment, vital signs are an effective index. If patients have significant hypotension or high fever, paramedics should consider immediate transport rather than BG measurement.

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Characteristics, Prehospital Management, and Outcomes in Patients Assessed for Hypoglycemia: Repeat Access to Prehospital or Emergency Care

Abstract: Although risk of repeat access to prehospital/ED care for patients with hypoglycemia exists, it was less common among patients taking insulin and was not predicted by an initial refusal of transport.

Cited by 14 publications

References 22 publications

Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study

Treat and Release for Patients Requiring Emergency Medical Services

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

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