The diagnostic utility of prehospital hyperglycaemia in major trauma patients: An observational study.

Abstract

Objectives: Stress-induced hyperglycaemia (SIH) is an elevated blood glucose level (≥11.1 mmol/L) in patients experiencing physiological stress, in the absence of diabetes mellitus. Although early in-hospital SIH has been associated with worse outcomes following major trauma, the predictive value of SIH in the prehospital setting has not been established. To investigate the role of prehospital SIH as a predictor of in-hospital mortality following major trauma.

Methods: A retrospective cohort study of non-diabetic, adult major trauma patients was undertaken to determine the association between prehospital SIH and in-hospital mortality. Secondary outcomes included ED disposition and ED length of stay.

Results: Of 1179 trauma patients included, 89 (8%) had SIH. Prehospital SIH was associated with higher Injury Severity Scores (median (interquartile range): 25 (17-33) vs 17 (14-25)), lower GCS (GCS 3-7: 48.3% vs 10.9%, P < 0.001), lower systolic BP (mean (SD): 122 (44.0) vs 133 (30.3)), lower oxygen saturations (mean (SD): 88% (16) vs 96% (7)) and abnormal heart and respiratory rate. The in-hospital mortality rate was 9.9% in non-SIH patients and 42.7% among patients with SIH (odds ratio (OR): 6.8; 95% confidence interval (CI): 4.3-10.8, P < 0.001). The area under the receiver operating curve for blood glucose alone in predicting mortality was 0.65 (95% CI: 0.60-0.70). Prehospital blood glucose was an independent predictor of mortality after adjustment for age, sex, GCS and vital signs (adjusted OR = 2.9; 95% CI: 1.5-5.5, P = 0.001).

Conclusion: The present study demonstrated an association between prehospital SIH and in-hospital mortality following major trauma. Further prospective research is warranted to examine the utility and integration of prehospital SIH into predicting models of trauma care.