Prehosp Emerg Care. 2019 Nov-Dec;23(6):780-787. doi: 10.1080/10903127.2019.1587125. Epub 2019 Mar 28.
: Symptomatic hypoglycemia frequently results in utilization of emergency medical services (EMS). Understanding the characteristics of hypoglycemic patients with high EMS utilization may help providers optimize resource allocation. : To describe characteristics of patients utilizing EMS for hypoglycemia and to determine if any factors identifiable in the prehospital setting are associated with recurrent EMS utilization. : A retrospective chart review of prehospital care records from an urban EMS system was performed. Patients who received oral glucose, parenteral glucose, or intramuscular glucagon for hypoglycemia over a one-year period were identified. Extracted information included demographics, prehospital treatment, disposition, zip code median income, and the number of subsequent EMS utilizations within 365 days. : We identified 549 subjects, mean age 55 years (range 5 to 104, 65% male). The mean glucose level for all patients was 44 mg/dl with standard deviation (SD) of 15. In total, 69% of patients received oral glucose, 26% received parenteral glucose, 3% received glucagon, and 2% received more than one medication. At the index visit, 81% of patients accepted hospital transportation. The rate of recurrent EMS utilization for hypoglycemia was 10%, and 3% of patients had 3 or more repeat utilizations within 365 days. The mean finger-stick glucose at index visit was 39 mg/dL (SD 15) for patients with multiple EMS utilizations and 44 mg/dL (SD 14) for those with one EMS visit (P = 0.006). Repeat utilizers were more likely to have received medications other than oral glucose at index visit, 51% vs. 28% (P < 0.001). Age, gender, median zip code income, and disposition were not associated with recurrent EMS utilization. The overall annual rate of hypoglycemia requiring EMS treatment per estimated diabetic population was 0.84%. A low proportion of patients utilizing EMS for hypoglycemia had subsequent EMS visits within 365 days. Those who did had lower initial blood glucose at the index visit and were more likely to have received prehospital treatment with medications other than oral glucose. Demographic characteristics did not yield any patterns predictive of repeat utilization. Refusing transport to the hospital after EMS treatment for hypoglycemia did not increase the risk of recurrent utilization.
：症状性低血糖经常导致紧急医疗服务（EMS）的利用。了解高 EMS 利用率的低血糖患者的特征可能有助于提供者优化资源分配。：描述利用 EMS 治疗低血糖的患者特征，并确定在院前环境中是否存在任何可识别的因素与反复利用 EMS 相关。：对城市 EMS 系统的院前护理记录进行回顾性图表审查。确定了在一年期间因低血糖接受口服葡萄糖、静脉葡萄糖或肌内葡萄糖的患者。提取的信息包括人口统计学资料、院前治疗、处置、邮政编码中位数收入以及 365 天内随后利用 EMS 的次数。：我们确定了 549 名患者，平均年龄为 55 岁（范围为 5 至 104 岁，65%为男性）。所有患者的平均血糖水平为 44mg/dl，标准差（SD）为 15。总共有 69%的患者接受口服葡萄糖，26%接受静脉葡萄糖，3%接受葡萄糖，2%接受超过一种药物。在指数就诊时，81%的患者接受医院转运。低血糖的 EMS 利用复发率为 10%，3%的患者在 365 天内有 3 次或更多重复利用。多次 EMS 利用的患者在指数就诊时的指尖血糖为 39mg/dL（SD 15），而单次 EMS 就诊的患者为 44mg/dL（SD 14）（P=0.006）。重复使用者更有可能在就诊时接受口服葡萄糖以外的药物治疗，分别为 51%和 28%（P<0.001）。年龄、性别、邮政编码中位数收入和处置与 EMS 利用的复发无相关性。按估计的糖尿病患者人数计算，每年需要 EMS 治疗的低血糖症发生率为 0.84%。利用 EMS 治疗低血糖的患者中，有一小部分在 365 天内再次利用 EMS。那些确实如此的患者在就诊时血糖初始水平较低，并且更有可能接受院前治疗，使用口服葡萄糖以外的药物。人口统计学特征没有显示出任何可预测重复利用的模式。在接受 EMS 治疗低血糖后拒绝转运至医院并不会增加复发利用的风险。
