Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis

摘要

BACKGROUNDDeranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce.OBJECTIVESThe primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone.DESIGNRetrospective analysis of the predefined, observational database of a nationwide Helicopter Emergency Medical Service (34 bases).SETTINGEmergency trauma patients treated by Helicopter Emergency Medical Service between 2005 and 2013 were investigated.PATIENTSAll adult trauma patients (18 years) with recorded blood glucose concentrations were enrolled.OUTCOMESPrimary outcome: upper and lower thresholds of blood glucose concentration more commonly associated with traumatic shock. Secondary outcome: additional predictive value of prehospital blood glucose concentrations when compared with vital parameters alone.RESULTSOf 51936 trauma patients, 20177 were included. In total, 220 (1.1%) patients died on scene. Hypoglycaemia (blood glucose concentration 2.8mmoll(-1) or less) was observed in 132 (0.7%) patients, hyperglycaemia (blood glucose concentration exceeding 15mmoll(-1)) was observed in 265 patients (1.3%). Blood glucose concentrations more than 10mmoll(-1) (n=1308 (6.5%)) and 2.8mmoll(-1) or less were more common in patients with traumatic shock (P0.0001). The Youden index for traumatic shock ((sensitivity+specificity)-1) was highest when blood glucose concentration was 3.35mmoll(-1) (P0.001) for patients with low blood glucose concentrations and 7.75mmol l(-1) (P0.001) for those with high blood glucose concentrations. In logistic regression analysis of patients with spontaneous circulation on scene, prehospital blood glucose concentrations (together with common vital parameters: Glasgow Coma Scale, heart rate, blood pressure, breathing frequency) significantly improved the prediction of traumatic shock in comparison with prediction by common vital parameters alone (P0.0001).CONCLUSIONIn adult trauma patients, low and high blood glucose concentrations were more common in patients with traumatic shock. Prehospital blood glucose concentration measurements in addition to common vital parameters may help identify patients at risk of traumatic shock.