Benoit Stephen R, Kahn Henry S, Geller Andrew I, Budnitz Daniel S, Mann N Clay, Dai Mengtao, Gregg Edward W, Geiss Linda S
Prehosp Emerg Care. 2018 Nov-Dec;22(6):705-712. doi: 10.1080/10903127.2018.1456582. Epub 2018 Apr 12.
The use of emergency medical services (EMS) for diabetes-related events is believed to be substantial but has not been quantified nationally despite the diverse acute complications associated with diabetes. We describe diabetes-related EMS activations in 2015 among people of all ages from 23 U.S. states.
We used data from 23 states that reported ≥95% of their EMS activations to the U.S. National Emergency Medical Services Information System (NEMSIS) in 2015. A diabetes-related EMS activation was defined using coded EMS provider impressions of "diabetes symptoms" and coded complaints recorded by dispatch of "diabetic problem." We described activations by type of location, urbanicity, U.S. Census Division, season, and time of day; and patient-events by age category, race/ethnicity, disposition, and treatment with glucose. Crude and age-adjusted diabetes-related EMS patient-level event rates were calculated for adults ≥18 years of age with diagnosed diabetes using the Behavioral Risk Factor Surveillance System to estimate the population denominator.
Of 10,324,031 relevant EMS records, 241,495 (2.3%) were diabetes-related activations, which involved over 235,000 hours of service. Most activations occurred in urban or suburban environ- ments (86.4%), in the home setting (73.5%), and were slightly more frequent in the summer months. Most patients (72.6%) were ≥45 years of age and over one-half (55.4%) were transported to the emergency department. The overall age-adjusted diabetes-related EMS event rate was 33.9 per 1,000 persons with diagnosed diabetes; rates were highest in patients 18-44 years of age, males, and non-Hispanic blacks and varied by U.S. Census Division.
Diabetes results in a substantial burden on EMS resources. Collection of more detailed diabetes complication information in NEMSIS may help facilitate EMS resource planning and prevention strategies.
尽管糖尿病存在多种急性并发症，但人们认为因糖尿病相关事件而使用紧急医疗服务（EMS）的情况相当普遍，不过全国范围内尚未对此进行量化。我们描述了2015年美国23个州各年龄段人群中与糖尿病相关的EMS启动情况。
我们使用了2015年向美国国家紧急医疗服务信息系统（NEMSIS）报告了≥95%的EMS启动情况的23个州的数据。与糖尿病相关的EMS启动是根据EMS提供者记录的“糖尿病症状”编码以及调度记录的“糖尿病问题”编码投诉来定义的。我们按地点类型、城市化程度、美国人口普查分区、季节和一天中的时间描述了启动情况；并按年龄类别、种族/族裔、处置方式和葡萄糖治疗情况描述了患者事件。使用行为危险因素监测系统估算总体分母，计算了年龄≥18岁且已确诊糖尿病的成年人中与糖尿病相关的EMS患者层面事件的粗发生率和年龄调整发生率。
在10324031条相关EMS记录中，241495条（2.3%）是与糖尿病相关的启动，涉及超过235000小时的服务。大多数启动发生在城市或郊区环境（86.4%）、家庭环境（73.5%），且在夏季月份略为频繁。大多数患者（72.6%）年龄≥45岁，超过一半（55.4%）被送往急诊科。与糖尿病相关的EMS事件总体年龄调整发生率为每1000名已确诊糖尿病患者33.9例；在18 - 44岁患者、男性以及非西班牙裔黑人中发生率最高，且因美国人口普查分区而异。
糖尿病给EMS资源带来了沉重负担。在NEMSIS中收集更详细的糖尿病并发症信息可能有助于促进EMS资源规划和预防策略。
