Abstract
Objective
Elevated blood glucose levels (BGL) are known to be part of the physiologic response
to stress following physical trauma. We aimed to study whether a measured BGL might
help improve accuracy of field triage.
Methods
We conducted a retrospective study using the Israel Defense Forces Trauma Registry.
BGLs were determined upon hospital arrival and were not available to medical providers
in the field.
Results
There were 706 casualties in the registry who had a recorded BGL upon hospital arrival.
Sixty percent (18/30) of casualties who had a BGL ≥200 mg/dL had been triaged in the field as severely wounded, whereas 11% (71/651)
of casualties who had a BGL <200 mg/dL had been triaged as severely wounded. For predicting an Injury Severity
Score >15, the positive likelihood ratio using field triage of severe was 11, using BGL ≥200 mg/dL was 8, and using a combination of the two tests was 26. For predicting the
need for intensive care unit (ICU) admission, the ratios were 8, 13, and 23, respectively.
Conclusions
Elevated BGL improved prediction of high Injury Severity Score and ICU use among casualties
triaged as severe. If future research using BGL measured in the field yields similar
results, combining BGL with standard field triage may allow for more accurate identification
of casualties who need acute field intervention, have major injury, or require ICU
admission.
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hyperglycemic response to trauma in combat casualties.J Trauma. 1971; 11: 337-339
- The stress response to trauma and surgery.Br J Anaesth. 2000; 85: 109-117
- Injury severity scoring.in: Moore E.E. Feliciano D.V. Mattox K.L. Trauma. 5th ed. McGraw-Hill, New York2004: 87-91
- Admission hyperglycemia is predictive of outcome in critically ill trauma patients.J Trauma. 2005; 59: 80-83
- Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.Ann Surg. 2010; 252: 597-602
- Relationship of early hyperglycemia to mortality in trauma patients.J Trauma. 2004; 56: 1058-1062
- Triage hyperglycemia as a prognostic indicator of major trauma.J Trauma. 2010; 69: 41-45
- Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion.J Trauma. 2003; 54: 312-319
- Relationship between admission hyperglycemia and neurologic outcome of severely brain-injured patients.Ann Surg. 1989; 210: 466
- Persistent nonketotic hyperglycemia as a grave prognostic sign in head-injured patients.Crit Care Med. 1981; 9: 838-840
- Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury.J Pediatr (Rio J). 2011; 87: 325-328
- Glucose as an adjunct triage tool to the Red Cross Wound Classification.J Trauma. 1996; 40: S144-S147
- Intensive insulin therapy in critically ill patients.N Engl J Med. 2001; 345: 1359-1367
- Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.JAMA. 2008; 300: 933-944
- Glucose in the ICU—evidence, guidelines, and outcomes.N Engl J Med. 2012; 367: 1259-1260
- Tight glycemic control in critically injured trauma patients.Ann Surg. 2007; 246: 605-610
Katzenell U, Yegorov Y, Tapia AL, et al. Triage in the military setting—the experience of IDF [Submitted].
Article Info
Publication History
Published online: February 04, 2013
Accepted:
October 29,
2012
Received in revised form:
October 9,
2012
Received:
August 6,
2012
Footnotes
☆Financial support: None.
☆☆Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
★Not presented previously.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
