Faculty Collaboration Database

Out-of-hospital treatment of hypoglycemia: refusal of transport and patient outcome. Acad Emerg Med 1998 Nov;5(11):1080-5

Date

12/03/1998

Pubmed ID

9835470

DOI

10.1111/j.1553-2712.1998.tb02666.x

Scopus ID

2-s2.0-0031738598 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

OBJECTIVES: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Author List

Socransky SJ, Pirrallo RG, Rubin JM

Author

Jonathan M. Rubin MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Allied Health Personnel
Diabetes Mellitus
Emergency Medical Services
Female
Humans
Hypoglycemia
Logistic Models
Male
Middle Aged
Patient Admission
Recurrence
Retrospective Studies
Transportation of Patients
Treatment Outcome
Treatment Refusal
Urban Population
Wisconsin