Department of Emergency Medicine, Division of Pediatric Emergency Medicine, University of South Carolina School of Medicine, Greenville, SC.
Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Winston-Salem, NC.
Acad Emerg Med. 2019 Dec;26(12):1379-1383. doi: 10.1111/acem.13834. Epub 2019 Sep 1.
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.
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.
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.
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).
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.
小儿癫痫在急救医疗服务（EMS）中很常见。有证据表明，在这种情况下低血糖的发生率很低，这对常规院前血糖检测的概念提出了挑战。
我们研究了与遵守小儿（<18 岁）因癫痫拨打 9-1-1 电话的 EMS 葡萄糖检测协议相关的因素，以及院前低血糖的发生率。
我们对 2013 年至 2014 年北卡罗来纳州 EMS 登记处的数据进行了回顾性分析。北卡罗来纳州 EMS 协议要求在癫痫治疗前测量血糖。纳入年龄≤17 岁、抱怨癫痫发作的患者的现场呼叫。我们计算了检测、低血糖的发生率以及葡萄糖测量的依从率的相对风险。
共 13182 例癫痫发作呼叫，其中 6262 例（47.5%，95%置信区间[CI]：46.6%至 48.3%）获得了血糖值。6262 例患者中有 78 例（1.25%，95%CI：0.97%至 1.5%）出现低血糖（血糖<60mg/dL）。61 例患者（中位数血糖 61mg/dL，四分位距[IQR]=51 至 67mg/dL）补充了葡萄糖。检测率随年龄增长而增加（相对风险[RR]：每增加 1 岁，RR=1.04，95%CI：1.03 至 1.04 岁），急救医疗技术员-护理师（EMT-P）的存在（RR=1.2，95%CI：1.1 至 1.3）和使用抗癫痫药物（RR=1.24，95%CI：1.1 至 1.2）。非白人患者的检测率较低（RR=0.95，95%CI：0.92 至 0.98）。
依从性不理想，随患者年龄、种族和 EMT-P 的存在而变化。当使用抗癫痫药物时，检测会增加。接受检测的患者中低血糖症并不常见；然而，如果不进行检测，将无法对低血糖性癫痫发作进行适当治疗。值得检查在这种情况下常规检测的效用；但是，在修改协议之前，区域 EMS 管理部门应专注于教育和统一遵守州协议。
