Utilisation of emergency medical services for severe hypoglycaemia: An unrecognised health care burden

Villani, Melanie; Nanayakkara, Natalie; Ranasinha, Sanjeeva; Tan, Chin Yao; Smith, Karen; Morgans, Amee; Soldatos, Georgia; Teede, Helena; Zoungas, Sophia

doi:10.1016/j.jdiacomp.2016.04.015

Cited by 30 publications

(33 citation statements)

References 18 publications

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“…Consistent with other reports, we found that non-transport was more likely among younger (e.g., adults <60 years) 15,16,21,23 or male 15,21 patients or for encounters during midnight to 6:00 am. 21,22 Other factors which have previously been found to be associated with non-transport but were not available in our study include insulin use, 15,17,21,22 type 1 diabetes, 20,21,23 not living alone 23 and multiple previous episodes.…”

Section: Discussionsupporting

confidence: 91%

“…21,22 Other factors which have previously been found to be associated with non-transport but were not available in our study include insulin use, 15,17,21,22 type 1 diabetes, 20,21,23 not living alone 23 and multiple previous episodes. 23 We also lacked data on comorbidities, medication use or insurance status; data on race/ethnicity were missing for 75% of encounters.…”

Section: Discussionmentioning

confidence: 82%

“…Finally, non-transport may depend on other factors not captured in our data, such as paramedic decision-making, patient preferences or alternative transport modes: Villani et al, for example, reported that 53% of non-transports were due to the EMS deeming transfer unnecessary, 38% were due to the patient refusing transport to hospital, and 8% were transported to hospital by private means or referred to a local medical officer. 21 A strength of our study was the full three years of data for Alameda County, which has a large and diverse population.…”

Section: Discussionmentioning

confidence: 99%

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Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Moffet¹,

Warton²,

Siegel³

et al. 2017

Prehospital Emergency Care

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Objective To estimate the rate, characteristics and dispositions of hypoglycemia events among persons who received care from Alameda County, California, Emergency Medical Services (EMS). Methods This study was based on data for 601,077 Alameda County EMS encounters during 2013–2015. Subjects were defined as having hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dl or “unspecified low”). The outcome of interest was patient transport or non-transport to an emergency department or other care setting; we excluded 33,177 (6%) encounters which lacked clear disposition outcomes. Results Among 567,900 eligible encounters, 8,332 (1.47%) were attributed to hypoglycemia, of which 1,125 (13.5%) were not transported. Non-transport was more likely among males, adult patients age <60, initial blood glucose >60 mg/dl or EMS arrival time 18:00 – 6:00. Conclusions Without an understanding of EMS encounters and non-transport rates, surveillance based solely on emergency department and hospital data will significantly underestimate rates of severe hypoglycemia. Additionally, given that hypoglycemia is often safely and effectively treated by non-physicians, EMS protocols should provide guidance for non-transport of hypoglycemic patients whose blood glucose levels have normalized.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Moffet¹,

Warton²,

Siegel³

et al. 2017

Prehospital Emergency Care

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“…In Makkah region during2017, 1 in 4 (27%) EMS encounters for hypoglycemia did not result in transport to ED.We took the data from the Saudi red crescent authority.Compared to some previous research we found the same result that non-transported was more likely among male patient or age from (40-59) 7,14,16,17 or patients for encounters during midnight to 6 AM. 7,17,9 The differentiation was in use dextrose 10% 7 which is more likely used in Saudi Arabia, maybe because EMS is more familiar with it but in the end it dependson condition of the patient.We ran out of time, and there isa shortage of data on types of diabetes, 11 pickup locations, destination, a repeated call from the same patient, 4 follow up the patient in the hospital and the improvement of the patient status.…”

Section: Discussionsupporting

confidence: 77%

“…7,17,9 The differentiation was in use dextrose 10% 7 which is more likely used in Saudi Arabia, maybe because EMS is more familiar with it but in the end it dependson condition of the patient.We ran out of time, and there isa shortage of data on types of diabetes, 11 pickup locations, destination, a repeated call from the same patient, 4 follow up the patient in the hospital and the improvement of the patient status. 8 The Patient who refused transport in some cases preferred alternative transport mode or EMS deeming transfer unnecessary.…”

Section: Discussionmentioning

confidence: 99%

Hypoglycemic Patient Transported by EMS inMakkah Region, 2017

Shammah

Mohammad

Helmi

et al. 2018

IJND

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Objective:To estimate the incident rate of the hypoglycemic patients transported by EMS and to evaluate EMS primary impression for these patients. Methods and Design: Retrospective, observational study was based on data for 150,563 SAUDI RED CRESENT AUTHORITY Transported Patients during 2017. Subjects were defined as having Hypoglycemia if EMS personnel recorded a primary impression of hypoglycemia or low blood glucose (<60 mg/dL Or "unspecified low"). The outcome of interest was patient transport or non-transport to an emergency department or other care settings. Results:Among 150,563 eligible encounters, 1984(1.29%) were diagnosed with hypoglycemia, of which 536 (27%) were not transported. Nontransported was more likely among male adult patients age (40-59), initial blood glucose <60 mg/dl or EMS arrival time midnight -6 A.M. Conclusion: A low rate of the non-transported patient to ED, Imperfect agreement between a primary impression of hypoglycemia and documented low blood glucose.

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Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: a prospective study

et al. 2019

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Aims/hypothesis The aim of this work was to investigate clinical outcomes following severe hypoglycaemia requiring prehospital emergency medical services (EMS) management. Methods We carried out a prospective, observational study of adults with diabetes attended by prehospital EMS for management of severe hypoglycaemia between April 2016 and July 2017. Information on precipitants, hospitalisation, length of hospital stay and recurrence was collected at 1 and 3 months following the episode of severe hypoglycaemia. Median and logistic regression models examined predictive factors. Results Five hundred and five adults (61% male, median age 67 years) participated in the study. Fifty-two per cent had type 1 diabetes, 43% type 2 diabetes and 5% were unsure of their diabetes type. Following EMS management of the index episode of severe hypoglycaemia, 50.3% were transported to hospital. Of those transported, 41.3% were admitted to hospital for ongoing management (20.8% of all participants). The following factors predicted hospital admission: older age (OR 1.28 [95% CI 1.02, 1.60] per 10 years), greater number of comorbidities (OR 1.27 [95% CI 1.08, 1.48] per morbidity), moderate-severe injury accompanying the hypoglycaemia (OR 5.24 [95% CI 1.07, 25.8] compared with nil-mild injury) and unknown cause of hypoglycaemia (OR 2.21 [95% CI 1.24, 3.94] compared with known cause). The median (interquartile range) length of hospital stay was 4 (2-7) days. During follow-up, recurrent severe hypoglycaemia attended by prehospital EMS was experienced by 10.7% of participants. Predictive factors of recurrent severe hypoglycaemia in 3 months were decreased HbA 1c (OR 1.97 [95% CI 1.27, 3.06] per 10 mmol/mol decrease) and a greater number of antecedent severe hypoglycaemia episodes (OR 1.12 [95% CI 1.03, 1.23] per episode). Conclusions/interpretation Following an episode of severe hypoglycaemia managed by EMS, one-fifth of participants required hospital admission, more likely in those with advancing age, increasing comorbidities and injury and one-tenth required EMS again for severe hypoglycaemia in a 3 month period, more likely in those with a greater number of antecedent episodes and lower HbA 1c . Knowledge of these factors associated with admission and recurrence provides an opportunity for development of targeted strategies aimed at prevention of severe hypoglycaemia in those most vulnerable.

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Utilisation of emergency medical services for severe hypoglycaemia: An unrecognised health care burden

Cited by 30 publications

References 18 publications

Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Hypoglycemia Patients and Transport by EMS in Alameda County, 2013–15

Hypoglycemic Patient Transported by EMS inMakkah Region, 2017

Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: a prospective study

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