Appropriateness of leaving emergency medical service treated hypoglycemic patients at home: a retrospective study

Background: Hypoglycemic patients treated by the emergency medical service (EMS) system are commonly left home. The criteria for leaving hypoglycemic patients at home and the appropriateness of the procedure remains, however, unvalidated. The present retrospective article addresses these questions. Methods: The Copenhagen physician-based mobile intensive care unit (MICU) responds to emergency calls in a two-tier rendezvous system. Its prehospital data from 1995 to 1998 were retrospectively incorporated into a clinical database and cross-referenced with clinical information from three Danish national registries, enabling identification of criteria for transportation of the patients to the hospital, and a detailed 72-h follow up on patients left at home. Results: The MICU treated 1148 hypoglycemic patients within the period, of which 84% were released at home. Treatment or no treatment before arrival of the MICU and level of consciousness following MICU treatment, were found to be strong predictors of a need for transportation to hospital; although other factors were implicated. Within the 72-h following MICU treatment less than 8% of the patients left at home needed secondary MICU or hospital treatment because of glucose regulatory problems, and less than 5% experienced secondary hypoglycemia. Less than 1% was admitted to hospital beds with recurrent hypoglycemia within 24h. Poor compliance with the diabetic treatment instructions often appeared to be involved in cases of recurrent hypoglycemia. A delay in admission was not to blame for a serious secondary patient course in any of the cases. Conclusion: The majority of patients with prehospital hypoglycemia may safely be treated and released at home in a physician-based EMS area.