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In patients with a glucose >400 mg/dL, does the discharge glucose level correlate with 7-day rate of return to the ED? There was no correlation with discharge glucose level and rate of ED return. I have always tried to make markedly elevated glucose numbers look better before discharge. This may be less beneficial than I thought. That said, pronounced hyperglycemia shouldn't be ignored on the basis of this study. DKA must be excluded, and patients may have significant volume depletion. The point is that achieving a specific target glucose number prior to discharge is probably not that important. EM Lit of Note has a good analysis on this as well as asymptomatic hypertension in the ED. Also Journal Watch covered this article.
Ann Emerg Med. 2016 Jun 25. pii: S0196-0644(16)30162-7. doi: 10.1016/j.annemergmed.2016.04.057. [Epub ahead of print]
1Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN. Electronic address: firstname.lastname@example.org.
2Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Hyperglycemia is frequently encountered in the emergency department (ED), and there is no consensus on optimal care before discharge. The importance of glucose reduction in the ED is unknown. We seek to determine whether an association exists between discharge glucose and 7-day adverse outcomes.
A cohort design with retrospective chart review was conducted at a high-volume urban ED. Patients were included if any glucose level was greater than or equal to 400 mg/dL and they were discharged from the ED. Generalized estimating equation models were created for the 7-day outcomes with a primary predictor of discharge glucose.
The cohort consisted of 422 patients with 566 ED encounters. Mean arrival and discharge glucose were 491 mg/dL (SD 82 mg/dL) and 334 mg/dL (SD 101 mg/dL), respectively. In the 7-day follow-up period, 62 (13%) and 36 (7%) patients had a repeat ED visit for hyperglycemia and were hospitalized, respectively. Two patients had diabetic ketoacidosis. After adjustment for arrival glucose, whether a chemistry panel was obtained, amount of intravenous fluids administered, and amount of subcutaneous insulin administered, discharge glucose was not associated with repeat ED visit for hyperglycemia (adjusted odds ratio 0.997; 95% confidence interval 0.993 to 1.001) or hospitalization for any reason (adjusted odds ratio 0.998; 95% confidence interval 0.995 to 1.002).
ED discharge glucose in patients with moderate to severe hyperglycemia was not associated with 7-day outcomes of repeat ED visit for hyperglycemia or hospitalization. Attaining a specific glucose goal before discharge in patients with hyperglycemia may be less important than traditionally thought.
Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
PMID: 27353284 [PubMed - as supplied by publisher]