OUT-OF-HOSPITAL TREATMENT OF HYPOGLYCEMIA - REFUSAL OF TRANSPORT AND PATIENT OUTCOME

Objectives: Patient refusal of transport after treatment of hypoglycem ia is common in urban emergency medical services (EMS) systems. The ra te of relapse is unknown. The goal of this study was to compare the ou tcomes of diabetic patients initially refusing transport (refusers) an d those transported to an ED. Methods: All paramedic runs from January to July 1995 were retrospectively reviewed. Inclusion criteria were a dult patients with a field assessment of hypoglycemic signs/symptoms, and a fingerstick glucose <80 mg/dL. Data for analysis included parame dic run duration, patient demographics, and refusal or acceptance of t ransport. Patient outcome was obtained from a review of hospital and m edical examiner records. Relapse was defined as hypoglycemia necessita ting EMS activation or an ED visit within 48 hours of the initial epis ode. Student's t-test and chi(2) analysis were used to compare means a nd rates, respectively. Results: Over the 7 months, 374 patients made 571 calls to 9-1-1 that met inclusion criteria (5.2% of all paramedic runs). Of these, 412 were refusers (72.2%) and 159 were transported pa tients (27.8%). The hospital records of 4 transported patients were un available. Sixty-three transported patients were admitted (11.2%), wit h 1 death from prolonged hypoglycemia. The rates of relapse did not di ffer between the refusers and the transported patients (p > 0.05). Twe nty-five relapses occurred among the refusers (6.1%), with 14 repeat r efusals, 11 transports, 5 admissions, and no deaths. There were 7 rela pses among the transported patients (4.4%), with 2 refusals, 5 transpo rts, 2 admissions, and no deaths. The paramedic run time was significa ntly shorter for the refusers than for the transported patients (p < 0 .05). Conclusions: The out-of-hospital treatment of hypoglycemic diabe tic patients appears to be effective and efficient. Independent of the patient's refusal or acceptance of transport, the out-of-hospital tre atment of hypoglycemic patients in this system appears to be safe.