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Prehospital Blood Glucose Testing as a Predictor of Impending Hypotension in Adult Trauma Patients

by

Joseph Hill RN, BSN, CMTE, CFRN1 David M. Gothard MS2 Michelle M. McLean MD, EMT-P, CHSE3

1Air Methods Corporation, Greenwood Village, CO 2Biostats, North East Canton, OH 3LifeNet of Michigan, Greenwood Village, CO

Abstract

Objective: Stress-induced hyperglycemia has been found to increase hemorrhagic shock, morbidity, and mortality in the trauma patient. The purpose of this study is to evaluate whether prehospital point-of-care glucose is an independent predictor of hypotension in the adult trauma patient transported by air ambulance to the receiving trauma center.

Methods: This retrospective chart review evaluated adult, nondiabetic trauma patients transported by air ambulance at 3 programs in the Midwest for the calendar year 2018. A total of 107 patients met the inclusion criteria. The primary analysis was the determination of an optimal cutoff for the blood glucose diagnostic for predicting a hypotensive outcome followed by chi-square incidence comparison.

Results: The optimal diagnostic cutoff point using Youden’s index (J) was determined to be a blood glucose value of 220 mg/dL or greater. Initial glucose values were associated with an increased relative risk of a hypotension outcome (P = .040). Glucose dichotomy was also associated with a mean decrease in systolic blood pressure during transport (P = .016).

Conclusion: The findings in this study indicate a point-of-care glucose measurement greater than 220 mg/dL should prompt prehospital clinicians to initiate aggressive balanced resuscitation before arrival at the receiving trauma center in order to prevent worsening hypotension and hemorrhagic shock.

Click below to read the full research paper published by ScienceDirect and the Air Medical Journal, Volume 39, Issue 1, January-February 2020, Pages 20-23