Is prehospital blood glucose measurement necessary in suspected cerebrovascular accident patients?

Abarbanell, Neal Robert

doi:10.1016/j.ajem.2005.01.004

Cited by 9 publications

(6 citation statements)

References 10 publications

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“…A single report suggests that a more selective approach may be possible, with blood glucose measurement advocated only in the presence of a history suspicious for hypoglycemia or inability to obtain adequate patient information. 29 That study is limited, however, by its retrospective methodology and an upper confidence interval of 2.4% for the likelihood of failing to identify a hypoglycemic patient. At present, checking blood glucose concentrations in most patients with stroke is a prudent step, even among patients without a history of diabetes mellitus or use of insulin.…”

Section: B Ems Managementmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams¹,

Zoppo²,

Alberts³

et al. 2007

Circulation

1,059

745

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Purpose-Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included. Key Words: AHA Scientific Statements Ⅲ emergency medical services Ⅲ stroke Ⅲ acute cerebral infarction Ⅲ tissue plasminogen activator †Deceased. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Methods-Members

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Section: B Ems Managementmentioning

confidence: 99%

Guidelines for the Early Management of Adults With Ischemic Stroke

Adams¹,

Zoppo²,

Alberts³

et al. 2007

Circulation

1,059

745

View full text Add to dashboard Cite

show abstract

“…Symptoms such as hemiparesis, hemiplegia, speech or visual disturbances, confusion, and poor coordination can all present in patients with hypoglycemia and can be corrected with administration of dextrose. 33 – 35 While symptoms such as tremulousness and altered behavior may occur with milder degrees of hypoglycemia, focal stroke-like neurological symptoms, such as hemiplegia, typically do not manifest until glucose levels are less than 45mg/dL. 36 – 38 There is a clear benefit to giving dextrose to those patients with glucose below 45mg/dL.…”

Section: Methodsmentioning

confidence: 99%

Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

Glober

Sporer

Guluma

et al. 2016

WestJEM

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IntroductionIn the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.MethodsWe performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.ResultsProtocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.ConclusionProtocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

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“…It could not have been determined which patients were transported to the hospital without BG measurement. Because brain injuries such as stroke are considered an emergency and are less likely to be associated with hypoglycaemia [5], BG measurement may not have been performed if the paramedics suspected such diseases. Patients with brain injury often develop fever and hypertension [11,19], and the results of our study would not have been signi cantly different from the present results even if they had been monitored.…”

Section: Limitationsmentioning

confidence: 99%

“…Although past medical history of diabetes mellitus and neurological examination ndings provide useful clinical information to determine whether hypoglycaemia is a potential cause of AMS [1,4,5], it is often di cult to obtain a detailed medical history and perform physical examination on the eld, especially for patients with AMS. Therefore, ndings of any simple, routine physical examination, such as vital signs, can be used to safely exclude patients with AMS who do not need BG measurement.…”

Section: Introductionmentioning

confidence: 99%

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

Mizu

Matsuoka

Huh

et al. 2020

Preprint

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BackgroundBlood glucose (BG) measurement by paramedics for patients with altered mental status is recommended as pre-hospital care in Japan. Therefore, paramedics prioritise BG measurement over transport to hospital even in emergency conditions such as hypotension or hypoxaemia. The purpose of this study was to examine the relationship between BG levels and vital signs, and to evaluate whether vital signs are effective in determining the necessity of BG measurement in pre-hospital settings. MethodsWe extracted data of patients who had BG measurements performed by paramedics in Kobe City from April 2015 to March 2019. We retrospectively investigated patient age, sex, presence of hypoglycaemia (BG level < 50 mg/dL) and vital signs. If a patient did not have hypoglycaemia and was transported to the Kobe City Medical Centre General Hospital, a final diagnosis was obtained. Patients aged below 15 years, and those with BG measurement errors, missing vital sign data, or a Japan Coma Scale 0 and I-digit codes were excluded. The χ2 test and Mann-Whitney U test were used for statistical analysis, and P<0.05 was considered statistically significant. ResultsOf the 1,791 patients, 1,242 were eligible for analysis (mean age, 71.9 years; 805 [58%] male). Hypoglycaemia was observed in 324 patients (26.1%). Of the 918 non-hypoglycaemic patients, 253 (27.6%) were transported to our hospital and stroke was the most common final diagnosis (61 patients [24.1%]). The non-hypoglycaemic group had more elderly patients than the hypoglycaemic group (median 73 vs. 76 years; P < 0.01). A significant difference in each vital sign were noted between hypoglycaemic and non-hypoglycaemic groups, with body temperature showing the highest difference between groups (area under the curve, 0.71; 95% confidence interval [CI], 0.68-0.74). Furthermore, in cases with systolic blood pressure being over 100 mmHg and body temperature being 38°C or less, it was highly unlikely that hypoglycaemia caused impaired consciousness (likelihood ratio 0.12 and 0.16; 95% CI 0.05-0.25 and 0.06-0.35, respectively). ConclusionWhen considering pre-hospital hypoglycaemia assessment, vital signs are an effective index. If patients have significant hypotension or high fever, paramedics should consider immediate transport rather than BG measurement.

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Is prehospital blood glucose measurement necessary in suspected cerebrovascular accident patients?

Cited by 9 publications

References 10 publications

Guidelines for the Early Management of Adults With Ischemic Stroke

Guidelines for the Early Management of Adults With Ischemic Stroke

Acute Stroke: Current Evidence-based Recommendations for Prehospital Care

Vital signs effectively predict non-hypoglycaemia in patients with altered mental status in pre-hospital settings: A retrospective analysis

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