Socransky S J, Pirrallo R G, Rubin J M
Department of Emergency Medicine, Sudbury Regional Hospital, ON, Canada.
Acad Emerg Med. 1998 Nov;5(11):1080-5. doi: 10.1111/j.1553-2712.1998.tb02666.x.
Patient refusal of transport after treatment of hypoglycemia is common in urban emergency medical services (EMS) systems. The rate of relapse is unknown. The goal of this study was to compare the outcomes of diabetic patients initially refusing transport (refusers) and those transported to an ED.
All paramedic runs from January to July 1995 were retrospectively reviewed. Inclusion criteria were adult patients with a field assessment of hypoglycemic signs/symptoms, and a fingerstick glucose <80 mg/dL. Data for analysis included paramedic run duration, patient demographics, and refusal or acceptance of transport. Patient outcome was obtained from a review of hospital and medical examiner records. Relapse was defined as hypoglycemia necessitating EMS activation or an ED visit within 48 hours of the initial episode. Student's t-test and chi2 analysis were used to compare means and rates, respectively.
Over the 7 months, 374 patients made 571 calls to 9-1-1 that met inclusion criteria (5.2% of all paramedic runs). Of these, 412 were refusers (72.2%) and 159 were transported patients (27.8%). The hospital records of 4 transported patients were unavailable. Sixty-three transported patients were admitted (11.2%), with 1 death from prolonged hypoglycemia. The rates of relapse did not differ between the refusers and the transported patients (p > 0.05). Twenty-five relapses occurred among the refusers (6.1%), with 14 repeat refusals, 11 transports, 5 admissions, and no deaths. There were 7 relapses among the transported patients (4.4%), with 2 refusals, 5 transports, 2 admissions, and no deaths. The paramedic run time was significantly shorter for the refusers than for the transported patients (p < 0.05).
The out-of-hospital treatment of hypoglycemic diabetic patients appears to be effective and efficient. Independent of the patient's refusal or acceptance of transport, the out-of-hospital treatment of hypoglycemic patients in this system appears to be safe.
在城市紧急医疗服务（EMS）系统中，低血糖治疗后患者拒绝转运的情况很常见。复发率尚不清楚。本研究的目的是比较最初拒绝转运的糖尿病患者（拒绝者）和被转运至急诊科的患者的结局。
回顾性分析了1995年1月至7月所有护理人员出诊记录。纳入标准为现场评估有低血糖体征/症状且指尖血糖<80mg/dL的成年患者。分析数据包括护理人员出诊时长、患者人口统计学信息以及拒绝或接受转运情况。通过查阅医院和法医记录获取患者结局。复发定义为在初次发作后48小时内需EMS出动或前往急诊科就诊的低血糖情况。分别使用学生t检验和卡方分析比较均值和发生率。
在这7个月期间，374例患者拨打了571次符合纳入标准的911电话（占所有护理人员出诊的5.2%）。其中，412例为拒绝者（72.2%），159例为被转运患者（27.8%）。4例被转运患者的医院记录无法获取。63例被转运患者入院（11.2%），1例因低血糖持续时间过长死亡。拒绝者和被转运患者的复发率无差异（p>0.05）。拒绝者中有25例复发（6.1%），其中14例再次拒绝，11例被转运，5例入院，无死亡。被转运患者中有7例复发（4.4%），其中2例拒绝，5例被转运，2例入院，无死亡。拒绝者的护理人员出诊时间显著短于被转运患者（p<0.05）。
低血糖糖尿病患者的院外治疗似乎有效且高效。在该系统中，无论患者拒绝或接受转运，低血糖患者的院外治疗似乎都是安全的。
