Driver Brian E, Olives Travis D, Bischof Johanna E, Salmen Marcus R, Miner James R
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Ann Emerg Med. 2016 Dec;68(6):697-705.e3. doi: 10.1016/j.annemergmed.2016.04.057. Epub 2016 Jun 25.
Hyperglycemia is frequently encountered in the emergency department (ED), and there is no consensus on optimal care before discharge. The importance of glucose reduction in the ED is unknown. We seek to determine whether an association exists between discharge glucose and 7-day adverse outcomes.
A cohort design with retrospective chart review was conducted at a high-volume urban ED. Patients were included if any glucose level was greater than or equal to 400 mg/dL and they were discharged from the ED. Generalized estimating equation models were created for the 7-day outcomes with a primary predictor of discharge glucose.
The cohort consisted of 422 patients with 566 ED encounters. Mean arrival and discharge glucose were 491 mg/dL (SD 82 mg/dL) and 334 mg/dL (SD 101 mg/dL), respectively. In the 7-day follow-up period, 62 (13%) and 36 (7%) patients had a repeat ED visit for hyperglycemia and were hospitalized, respectively. Two patients had diabetic ketoacidosis. After adjustment for arrival glucose, whether a chemistry panel was obtained, amount of intravenous fluids administered, and amount of subcutaneous insulin administered, discharge glucose was not associated with repeat ED visit for hyperglycemia (adjusted odds ratio 0.997; 95% confidence interval 0.993 to 1.001) or hospitalization for any reason (adjusted odds ratio 0.998; 95% confidence interval 0.995 to 1.002).
ED discharge glucose in patients with moderate to severe hyperglycemia was not associated with 7-day outcomes of repeat ED visit for hyperglycemia or hospitalization. Attaining a specific glucose goal before discharge in patients with hyperglycemia may be less important than traditionally thought.
高血糖在急诊科（ED）较为常见，对于出院前的最佳治疗方案尚无共识。在急诊科降低血糖的重要性尚不清楚。我们试图确定出院时的血糖水平与7天不良结局之间是否存在关联。
在一家繁忙的城市急诊科采用回顾性病历审查的队列设计。纳入标准为任何血糖水平大于或等于400mg/dL且从急诊科出院的患者。以出院时血糖作为主要预测因素，建立广义估计方程模型来分析7天结局。
该队列包括422例患者，共566次急诊科就诊。平均就诊时血糖和出院时血糖分别为491mg/dL（标准差82mg/dL）和334mg/dL（标准差101mg/dL）。在7天随访期内，分别有62例（13%）和36例（7%）患者因高血糖再次到急诊科就诊和住院。2例患者发生糖尿病酮症酸中毒。在调整了就诊时血糖、是否进行了生化检查、静脉补液量和皮下胰岛素用量后，出院时血糖与因高血糖再次到急诊科就诊（调整后的优势比为0.997；95%置信区间为0.993至1.001）或因任何原因住院（调整后的优势比为0.998；95%置信区间为0.995至1.002）均无关联。
中度至重度高血糖患者的急诊科出院时血糖与7天内因高血糖再次到急诊科就诊或住院的结局无关。对于高血糖患者，在出院前达到特定的血糖目标可能没有传统认为的那么重要。
