When Should You Test for and Treat Hypoglycemia in Prehospital Seizure Patients?

Beskind, Daniel; Rhodes, Suzanne Michelle; Stolz, Uwe; Birrer, Brett; Mayfield, Thomas R.; Bourn, Scott S.; Denninghoff, Kurt R.

doi:10.3109/10903127.2013.864358

Cited by 16 publications

(15 citation statements)

References 26 publications

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“…The majority of pediatric patients undergoing blood glucose monitoring and receiving treatment for hypoglycemia in the prehospital setting have a chief complaint of seizure . In contrast, Beskind et al . found that hypoglycemia was a rare event in EMS calls for seizures (1.2%) when examining a combined adult and pediatric population.…”

Section: Goals Of This Investigationmentioning

confidence: 97%

Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study

Burroughs

Mitchell²,

Hiestand

et al. 2019

Academic Emergency Medicine

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Background: Pediatric seizures are commonly encountered in emergency medical services (EMS). Evidence is accumulating that the rate of hypoglycemia in this setting is low, challenging the concept of routine prehospital glucose measurement.Objective: We studied factors associated with EMS protocol compliance for glucose testing in children < 18 years of age with a 9-1-1 call for seizure as well as rates of hypoglycemia in the prehospital setting. Methods:We performed a retrospective analysis of data from the North Carolina EMS registry from 2013 to 2014. North Carolina EMS protocols require glucose measurement prior to seizure treatment. Scene calls for patients ≤ 17 years with a complaint of seizure were included. We calculated incidence of testing, hypoglycemia, and the relative risk of compliance with glucose measurement.Results: There were 13,182 calls for seizure, of which 6,262 (47.5%, 95% confidence interval [CI] = 46.6% to 48.3%) had a glucose obtained. Hypoglycemia (glucose < 60 mg/dL) was present in 78 of 6,262 (1.25%, 95% CI = 0.97% to 1.5%) patients. Glucose was supplemented in 61 patients (median glucose 61 mg/dL, interquartile range = 51 to 67 mg/dL). Testing rates increased with age (relative risk [RR] = 1.04 per year, 95% CI = 1.03-1.04 per year), emergency medical technician-paramedic (EMT-P) presence (RR = 1.2, 95% CI = 1.1-1.3) and with antiepileptic medication use (RR = 1.24, 95% CI = 1.1 to 1.2). Testing was less likely in nonwhite patients (RR = 0.95, 95% CI = 0.92 to 0.98). Conclusions:Compliance is suboptimal, varying with patient age, race, and EMT-P presence. Testing increases when antiepileptic drugs are used. Hypoglycemia in tested patients was infrequent; however, proper treatment for hypoglycemic seizures will not be delivered if testing does not occur. It is worthwhile examining the utility of routine testing in this setting; however, until such time as protocols are revised, regional EMS administration should focus on education and uniform compliance with state protocols.From the

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Section: Goals Of This Investigationmentioning

confidence: 97%

Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study

Burroughs

Mitchell²,

Hiestand

et al. 2019

Academic Emergency Medicine

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“…There has been little agreement on when this testing should be performed since hypoglycemia can manifest as seizures, but checking blood glucose may delay the administration of benzodiazepines 12. While some protocols require checking blood glucose prior to the administration of benzodiazepines, others leave the timing to the discretion of the treating paramedic 4,12…”

Section: Evidence Review and Current Recommendationsmentioning

confidence: 99%

“…In a retrospective observational study of 53,505 EMS calls for seizure where blood glucose was measured, hypoglycemia was present in 638 (1.2%) patients with seizures 12. Seizing patients were treated with benzodiazepine in 8.3% and with glucose in 1.3% of patients.…”

Section: Evidence Review and Current Recommendationsmentioning

confidence: 99%

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Silverman¹,

Sporer²,

Lemieux³

et al. 2017

WestJEM

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IntroductionWe sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California.MethodsWe performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately.ResultsProtocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33) of agencies for adult patients and 76% (25/33) for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33) have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33) of agencies. Forty-two percent (14/33) have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33) allow benzodiazepines to be administered.ConclusionProtocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols.

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“…Although hypoglycaemia is an uncommon cause of SE, it is readily reversible . Glucose testing should not delay the administration of benzodiazepines …”

Section: Resultsmentioning

confidence: 99%

“…11 Glucose testing should not delay the administration of benzodiazepines. 37,38 Australasian pre-hospital protocols…”

Section: Blood Glucosementioning

confidence: 99%

Review article: Paediatric status epilepticus in the pre‐hospital setting: An update

Furyk

Watt

Emeto

et al. 2017

Emerg Medicine Australasia

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Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.

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When Should You Test for and Treat Hypoglycemia in Prehospital Seizure Patients?

Cited by 16 publications

References 26 publications

Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study

Prehospital Care of Pediatric Hypoglycemic Seizure Patients in the State of North Carolina: A Retrospective Cohort Study

Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations

Review article: Paediatric status epilepticus in the pre‐hospital setting: An update

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