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Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management

机译：癫痫发作儿童的预科葡萄糖测试：拟议的管理变动

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Objective: Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED). Methods: This was a retrospective, IRB-approved chart analysis of all pediatric patients (14years) transported by EMS to the Harbor-UCLA pediatric ED over a 2-year period with a chief complaint of seizure. Cases were selected in which witnessed seizures had occurred in the field by family or EMS. Chart review included prehospital, nursing and physician records. Hypoglycemia was defined as blood glucose <60mg/dL. Analysis included blood glucose, witnessed field seizure, initial mental status assessed by Glasgow Coma Scale (GCS), and further mental status assessments, along with age, sex, and medical history. Medical records were reviewed for subsequent BGT and patient outcome. Results: A total 770 children were transported by EMS due to seizures. Four patients (0.5%) had recorded hypoglycemia in the field, yet only two received treatment to raise blood glucose. Additionally, one child (0.1%) was normoglycemic (81mg/dL) in the field with hypoglycemia (43mg/dL) in the ED but required no intervention. Two were found by EMS to have an ALOC (GCS 12) and hypoglycemia. Only the patient with hypoglycemia secondary to a suspected glipizide ingestion received ED glucose administration. The most common discharge diagnosis was simple febrile seizure (38.6%). Conclusion: Hypoglycemia in the pediatric seizure patient is extremely rare, thus universal field BGT has low utility and potential downstream effects. We propose a novel algorithm for the initial evaluation and management of prehospital pediatric seizures. Although limited to a retrospective analysis of a single medical center, our findings suggest the importance of reassessing prehospital seizure protocols. A larger patient sample should be studied to validate these findings and identify unique cases where glucose testing might be useful.
机译：目的：许多急诊医学服务（EMS）方案需要针对任何癫痫发作或改变的有意识水平呈现的儿科患者的护理血糖测试（BGT）。在所有儿科癫痫发作时，少数数据描述了BGT的诊断产量，无论呈现精神状态。我们分析了患有先前癫痫发作的儿科患者的大型单中心数据集，以确定急诊部（ED）在急诊部（ED）中重复BGT的普及和效用。方法：这是对EMS运送的所有儿科患者（14年）的回顾性，IRB批准的图表分析，在2年期间，EMS运送到港口UCLA儿科ED。选择案件，其中在该领域发生了目睹癫痫发作。图表审查包括预竞技，护理和医师记录。低血糖定义为血糖<60mg / dL。分析包括血糖，目睹现场癫痫发作，Glasgow Coma Scale（GCS）评估的初始精神状态，以及进一步的心理状态评估，以及年龄，性别和病史。对后续BGT和患者结果进行了审查了病程。结果：由于癫痫发作，EMS运输了770名儿童。四名患者（0.5％）在该领域记录了低血糖，但只有两个接受的治疗方法以提高血糖。此外，一个孩子（0.1％）是在腺血糖（43mg / dL）的田间中的常血糖（81mg / dl），但不需要干预。 EMS发现两种含有Aloc（GCS 12）和低血糖。只有患有低血糖的患者继发于疑似粘吡吡吡吡吡吡吡吡吡吡吡吡吡吡吡吡吡甲醚摄入的ED葡萄糖给药。最常见的放电诊断是简单的发热癫痫发作（38.6％）。结论：儿科癫痫发作患者的低血糖是极少数，因此通用田BGT具有低效用和潜在的下游效果。我们提出了一种新的初始评估和管理前孢子癫痫发作的新算法。虽然仅限于对单一医疗中心的回顾性分析，但我们的研究结果表明重新评估了预先审查了癫痫发作协议的重要性。应研究较大的患者样品以验证这些发现，并确定葡萄糖测试可能有用的独特情况。

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