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71. Prospective Evaluation of Criteria Allowing Paramedics to Treat and Release Patients Presenting with Hypoglycemia

Published online by Cambridge University Press:  28 June 2012

Robert W. Wolford ,
William Tisol ,
Peter Vasilenko ,
Robert M. Domeier  and
Susan Bignall Owensby
Robert W. Wolford
Affiliation:
College of Human Medicine, Michigan State University, Saginaw Campus, Saginaw, Michigan, USA Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan, USA
William Tisol
Affiliation:
College of Human Medicine, Michigan State University, Saginaw Campus, Saginaw, Michigan, USA Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan, USA
Peter Vasilenko
Affiliation:
College of Human Medicine, Michigan State University, Saginaw Campus, Saginaw, Michigan, USA Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan, USA
Robert M. Domeier
Affiliation:
Emergency Medicine Residency Program, University of Michigan/St. Joseph Mercy Hospital, Ann Arbor, Michigan, USA
Susan Bignall Owensby
Affiliation:
College of Human Medicine, Michigan State University, Saginaw Campus, Saginaw, Michigan, USA Saginaw Cooperative Hospitals, Inc., Saginaw, Michigan, USA
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Purpose: Criteria (T&R) have been proposed to identify hypoglycemic patients who may be treated in the field and released without transport to the hospital. We prospectively evaluated the validity of these criteria.

Methods: Patients presenting with hypoglycemia (blood glucose [BG] <80 mg/dL) to paramedics of 2 EMS systems were prospectively enrolled and the presence of T&R criteria determined. T&R criteria did not influence transport. Hospital records were reviewed to determine interventions and outcomes.

Results: A total of 151 patients were enrolled (58% male, age 56 years (range 12–94), BG 33 ±16 mg/dL) and 99 (66%) were transported to the hospital and used to test the T&R criteria. Fifty-six patients (57%) were discharged from the ED and 43 (43%) received additional medications, or were admitted. T&R criteria identified 28 (29%) patients as appropriate for treatment and release. Of these, 5/28 (18%) received additional dextrose 50% (D50) or admission; 3 received D50 (despite normal mental status and documented ED BG >100 mg/dL), and 2 were admitted (transient ischemic attack and 1 hospital day, hypoglycemia and gastroenteritis and 2 hospital days). Sensitivity, specificity, negative and positive predictive values for the T&R criteria were: 41%, 88%, 51%, and 82%, respectively, and 44%, 95%, 54%, and 93%, respectively, if the 3 cases receiving D50 despite BG>100 mg/dL are excluded.

Type
Oral Presentations
Information
Prehospital and Disaster Medicine , Volume 11 , supplement S2: Abstracts of Scientific Papers. The Twelth Annual Conference and Scientific Assembly of the National Association of EMS Physicians, 13-15 July 1996, Loews Coronado Bay Resort, San Diego, California, USA , September 1996 , pp. S36
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1996