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首页> 外文期刊>Canadian Journal of Emergency Medicine >Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies
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Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies

机译：对糖尿病急诊患者进行前哨检查，以作为高血糖紧急情况的警告信号

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ObjectivesPatients with poorly controlled diabetes mellitus may have a sentinel emergency department (ED) visit for a precipitating condition prior to presenting for a hyperglycemic emergency, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). This study’s objective was to describe the epidemiology and outcomes of patients with a sentinel ED visit prior to their hyperglycemic emergency visit.MethodsThis was a 1-year health records review of patients≥18 years old presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, DKA, or HHS. Trained research personnel collected data on patient characteristics, management, disposition, and determined whether patients came to the ED within the 14 days prior to their hyperglycemia visit. Descriptive statistics were used to summarize the data.ResultsOf 833 visits for hyperglycemia, 142 (17.0%; 95% CI: 14.5% to 19.6%) had a sentinel ED presentation within the preceding 14 days. Mean (SD) age was 50.5 (19.0) years and 54.4% were male; 104 (73.2%) were discharged from this initial visit, and 98/104 (94.2%) were discharged either without their glucose checked or with an elevated blood glucose (&11.0 mmol/L). Of the sentinel visits, 93 (65.5%) were for hyperglycemia and 22 (15.5%) for infection. Upon returning to the ED, 61/142 (43.0%) were admitted for severe hyperglycemia, DKA, or HHS.ConclusionIn this unique ED-based study, diabetic patients with a sentinel ED visit often returned and required subsequent admission for hyperglycemia. Clinicians should be vigilant in checking blood glucose and provide clear discharge instructions for follow-up and glucose management to prevent further hyperglycemic emergencies from occurring.
机译：目的糖尿病控制不佳的患者在出现高血糖紧急情况（例如糖尿病性酮症酸中毒（DKA）或高渗性高血糖状态（HHS））之前，可能需要先哨兵急诊科（ED）以寻找病情。本研究的目的是描述高血糖急诊就诊前哨ED患者的流行病学和结局。方法这是对18岁以上≥4岁的四级急诊ED之一出院的1年健康记录进行的回顾。诊断高血糖，DKA或HHS。受过训练的研究人员收集了有关患者特征，治疗，处置的数据，并确定患者是否在高血糖访视前14天内就诊。使用描述性统计数据对数据进行汇总。结果在833例高血糖访视中，有142例（17.0％; 95％CI：14.5％至19.6％）在前14天内进行了前哨ED表现。平均（SD）年龄为50.5（19.0）岁，男性为54.4％;从该初次就诊中排出104（73.2％），并且在不检查其葡萄糖或血糖升高（＞ 11.0mmol / L）的情况下排出98/104（94.2％）。在前哨就诊中，有93（65.5％）是高血糖，有22（15.5％）是感染。返回急诊室后，接受重度高血糖，DKA或HHS的患者占61/142（43.0％）。结论在这项基于急诊室的独特研究中，糖尿病患者进行了前哨急诊室就诊，通常需要再次接受高血糖治疗。临床医生应保持警惕，检查血糖，并为随访和血糖管理提供明确的出院指导，以防止发生进一步的高血糖紧急情况。

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