Remick Katherine, Redgate Christopher, Ostermayer Daniel, Kaji Amy H, Gausche-Hill Marianne
Prehosp Emerg Care. 2017 Mar-Apr;21(2):216-221. doi: 10.1080/10903127.2016.1218979. Epub 2016 Sep 16.
Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED).
This was a retrospective, IRB-approved chart analysis of all pediatric patients (≤14 years) transported by EMS to the Harbor-UCLA pediatric ED over a 2-year period with a chief complaint of seizure. Cases were selected in which witnessed seizures had occurred in the field by family or EMS. Chart review included prehospital, nursing and physician records. Hypoglycemia was defined as blood glucose <60 mg/dL. Analysis included blood glucose, witnessed field seizure, initial mental status assessed by Glasgow Coma Scale (GCS), and further mental status assessments, along with age, sex, and medical history. Medical records were reviewed for subsequent BGT and patient outcome.
A total 770 children were transported by EMS due to seizures. Four patients (0.5%) had recorded hypoglycemia in the field, yet only two received treatment to raise blood glucose. Additionally, one child (0.1%) was normoglycemic (81 mg/dL) in the field with hypoglycemia (43 mg/dL) in the ED but required no intervention. Two were found by EMS to have an ALOC (GCS ≤ 12) and hypoglycemia. Only the patient with hypoglycemia secondary to a suspected glipizide ingestion received ED glucose administration. The most common discharge diagnosis was simple febrile seizure (38.6%).
Hypoglycemia in the pediatric seizure patient is extremely rare, thus universal field BGT has low utility and potential downstream effects. We propose a novel algorithm for the initial evaluation and management of prehospital pediatric seizures. Although limited to a retrospective analysis of a single medical center, our findings suggest the importance of reassessing prehospital seizure protocols. A larger patient sample should be studied to validate these findings and identify unique cases where glucose testing might be useful.
许多急诊医疗服务（EMS）协议要求对任何出现癫痫发作或意识水平改变的儿科患者进行即时血糖检测（BGT）。很少有数据描述在无论精神状态如何的所有儿科癫痫发作中进行BGT的诊断率。我们分析了一个大型单中心数据集，该数据集包含了因院前癫痫发作而就诊的儿科患者，以确定低血糖性癫痫的患病率以及急诊科（ED）重复进行BGT的效用。
这是一项经机构审查委员会（IRB）批准的回顾性图表分析，研究对象为在两年期间由EMS转运至哈伯-加州大学洛杉矶分校儿科急诊科的所有儿科患者（≤14岁），主要诉求为癫痫发作。入选病例为在现场有家人或EMS目睹癫痫发作的情况。图表审查包括院前、护理和医生记录。低血糖定义为血糖<60mg/dL。分析内容包括血糖、现场目睹的癫痫发作、通过格拉斯哥昏迷量表（GCS）评估的初始精神状态以及进一步的精神状态评估，以及年龄、性别和病史。审查病历以了解后续的BGT和患者结局。
共有770名儿童因癫痫发作被EMS转运。4名患者（0.5%）在现场记录有低血糖，但只有2名接受了升高血糖的治疗。此外，1名儿童（儿童（0.1%）在现场血糖正常（81mg/dL），但在急诊科低血糖（43mg/dL），但无需干预。EMS发现2名患者存在意识水平改变（GCS≤12）且有低血糖。只有因疑似服用格列吡嗪继发低血糖的患者在急诊科接受了葡萄糖给药。最常见出院诊断为单纯热性惊厥（38.6%）。
儿科癫痫患者低血糖极为罕见，因此普遍在现场进行BGT效用较低且可能产生下游影响。我们提出了一种针对院前儿科癫痫发作初始评估和管理的新算法。尽管本研究仅限于对单个医疗中心的回顾性分析，但我们的研究结果表明重新评估院前癫痫发作协议的重要性。应研究更大的患者样本以验证这些结果，并确定血糖检测可能有用的特殊病例。
