Regional Paramedic Program for Eastern Ontario, Ottawa, Ontario.
Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario.
Prehosp Emerg Care. 2023;27(7):955-966. doi: 10.1080/10903127.2022.2137863. Epub 2022 Nov 8.
The objectives of this study were to describe the characteristics, management, and outcomes of patients treated by paramedics for hypoglycemia, and to determine the predictors of hospital admission for these patients within 72 hours of the initial hypoglycemia event.
We performed a health record review of paramedic call reports and emergency department records over a 12-month period. We queried prehospital databases to identify cases, which included all patients ⩾18 years with prehospital glucose readings of <72 mg/dl (<4.0 mmol/L) and excluded terminally ill and cardiac arrest patients. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions before initiation of data extraction by trained investigators. Data analyses included descriptive statistics univariate and logistic regression presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).
There were 791 patients with the following characteristics: mean age 56.2, male 52.3%, type 1 diabetes 11.6%, on insulin 43.3%, median initial glucose 54.0 mg/dl (3.0 mmol/L), from home 56.4%. They were treated by advanced care paramedics 80.1%, received intravenous D50 37.8%, intramuscular glucagon 17.8%, oral complex carbs/protein 25.7%, and accepted transport to hospital 70.2%. Among those transported, 134 (24.3%) were initially admitted and four more were admitted within 72 hours. One patient was admitted, discharged, and admitted again within 72 hours. Patients without documented histories of diabetes (aOR 2.35, CI 1.13-4.86), with cardiovascular disease (aOR 1.81, CI 1.10-3.00), on corticosteroids (aOR 4.63, CI 2.15-9.96), on oral hypoglycemic agent(s) (aOR 1.92, CI 1.02-3.62), or those given glucagon (aOR 1.77, CI 1.07-2.93) on scene were more likely to be admitted to hospital, whereas patients on insulin (aOR 0.49, CI 0.27-0.91), able to tolerate complex oral carbs/protein (aOR 0.22, CI 0.10-0.48), with final GCS scores of 15 (aOR 0.53, CI 0.34-0.83), or from public locations (aOR 0.40, CI 0.21-0.75) were less likely to be admitted.
There are several patient and prehospital management characteristics which, in combination, could be incorporated into a safe clinical decision tool for patients who present with hypoglycemia.
本研究旨在描述接受护理人员治疗的低血糖患者的特征、治疗方法和结局，并确定这些患者在最初低血糖事件发生后 72 小时内住院的预测因素。
我们对 12 个月期间的护理人员呼叫报告和急诊部记录进行了健康记录回顾。我们通过院前数据库查询了病例，包括所有 ⩾18 岁、院前血糖读数 ⩽72mg/dl（ ⩽4.0mmol/L）的患者，排除临终和心脏骤停患者。我们开发并试行标准化数据收集工具，并在训练有素的调查人员开始提取数据之前，就所有数据定义达成共识。数据分析包括描述性统计、单变量和逻辑回归，表现为调整后的优势比（aOR）和 95%置信区间（95%CI）。
共有 791 名患者具有以下特征：平均年龄 56.2 岁，男性占 52.3%，1 型糖尿病占 11.6%，使用胰岛素占 43.3%，初始血糖中位数为 54.0mg/dl（3.0mmol/L），发病地点在家中占 56.4%。他们由高级护理人员治疗 80.1%，接受静脉滴注 D50 占 37.8%，肌肉内给予胰高血糖素占 17.8%，口服复合碳水化合物/蛋白质占 25.7%，并接受送往医院的治疗占 70.2%。在接受运送的患者中，134 名（24.3%）患者最初入院，另有 4 名患者在 72 小时内入院。一名患者在 72 小时内入院、出院并再次入院。没有记录糖尿病病史的患者（aOR 2.35，CI 1.13-4.86）、有心血管疾病的患者（aOR 1.81，CI 1.10-3.00）、使用皮质类固醇的患者（aOR 4.63，CI 2.15-9.96）、使用口服降糖药的患者（aOR 1.92，CI 1.02-3.62）或在现场接受胰高血糖素治疗的患者（aOR 1.77，CI 1.07-2.93）更有可能被收治入院，而使用胰岛素的患者（aOR 0.49，CI 0.27-0.91）、能够耐受复合口服碳水化合物/蛋白质的患者（aOR 0.22，CI 0.10-0.48）、最终格拉斯哥昏迷量表评分（GCS）为 15 的患者（aOR 0.53，CI 0.34-0.83）或来自公共场所的患者（aOR 0.40，CI 0.21-0.75）则不太可能被收治入院。
存在一些患者和院前管理特征，如果将这些特征结合起来，可以纳入低血糖患者安全的临床决策工具。
