Advertisement

Blood glucose levels as an adjunct for prehospital field triage

Published:February 04, 2013DOI:https://doi.org/10.1016/j.ajem.2012.10.038

      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 Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McNamara J.J.
        • Molot M.
        • Stremple J.F.
        • et al.
        Hyperglycemic response to trauma in combat casualties.
        J Trauma. 1971; 11: 337-339
        • Desborough J.P.
        The stress response to trauma and surgery.
        Br J Anaesth. 2000; 85: 109-117
        • Maurer A.
        • Morris Jr., J.A.
        Injury severity scoring.
        in: Moore E.E. Feliciano D.V. Mattox K.L. Trauma. 5th ed. McGraw-Hill, New York2004: 87-91
        • Sung J.
        • Bochicchio G.V.
        • Joshi M.
        • et al.
        Admission hyperglycemia is predictive of outcome in critically ill trauma patients.
        J Trauma. 2005; 59: 80-83
        • Bochicchio G.V.
        • Bochicchio K.M.
        • Joshi M.
        • et al.
        Acute glucose elevation is highly predictive of infection and outcome in critically injured trauma patients.
        Ann Surg. 2010; 252: 597-602
        • Laird A.M.
        • Miller P.R.
        • Kilgo P.D.
        • et al.
        Relationship of early hyperglycemia to mortality in trauma patients.
        J Trauma. 2004; 56: 1058-1062
        • Paladino L.
        • Subramanian R.A.
        • Nabors S.
        • et al.
        Triage hyperglycemia as a prognostic indicator of major trauma.
        J Trauma. 2010; 69: 41-45
        • Jeremitsky E.
        • Omert L.
        • Dunham C.M.
        • et al.
        Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion.
        J Trauma. 2003; 54: 312-319
        • Young B.
        Relationship between admission hyperglycemia and neurologic outcome of severely brain-injured patients.
        Ann Surg. 1989; 210: 466
        • Merguerian P.A.
        Persistent nonketotic hyperglycemia as a grave prognostic sign in head-injured patients.
        Crit Care Med. 1981; 9: 838-840
        • Aşılıoğlu N.
        • Turna F.
        • Paksu M.S.
        Admission hyperglycemia is a reliable outcome predictor in children with severe traumatic brain injury.
        J Pediatr (Rio J). 2011; 87: 325-328
        • Savić J.
        • Cernak I.
        • Jevtić M.
        • et al.
        Glucose as an adjunct triage tool to the Red Cross Wound Classification.
        J Trauma. 1996; 40: S144-S147
        • van den Berghe G.
        • Wouters P.
        • Weekers F.
        • et al.
        Intensive insulin therapy in critically ill patients.
        N Engl J Med. 2001; 345: 1359-1367
        • Wiener R.S.
        • Wiener D.
        • Larson R.J.
        Benefits and risks of tight glucose control in critically ill adults: a meta-analysis.
        JAMA. 2008; 300: 933-944
        • Kavanagh B.P.
        Glucose in the ICU—evidence, guidelines, and outcomes.
        N Engl J Med. 2012; 367: 1259-1260
        • Scalea T.M.
        • Bochicchio G.V.
        • Bochicchio K.M.
        • et al.
        Tight glycemic control in critically injured trauma patients.
        Ann Surg. 2007; 246: 605-610
      1. Katzenell U, Yegorov Y, Tapia AL, et al. Triage in the military setting—the experience of IDF [Submitted].