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Paediatric hypoglycaemia; are we investigating appropriately and adequately?
Louise Ramsden1, Katherine Wright2, Anuja Natarajan2
1Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
Postgraduate Medical Journal
|April 9, 2017
Summary
Paediatric hypoglycaemia investigations are often incomplete or inappropriate, leading to significant costs and potential diagnostic delays. Improved national guidance is needed for investigation thresholds and normal ranges to ensure timely and accurate diagnosis.
Area of Science:
- Pediatrics
- Clinical Chemistry
- Endocrinology
Background:
- Paediatric hypoglycaemia is a common medical emergency requiring prompt investigation.
- Inadequate investigations can lead to further costs and patient safety issues.
Purpose of the Study:
- To evaluate the completeness and appropriateness of investigations for paediatric hypoglycaemia.
- To assess the cost implications of current investigation practices.
Main Methods:
- Reviewed clinical notes and laboratory data for 49 cases of proven or suspected paediatric hypoglycaemia (glucose ≤2.6 mmol/L).
- Assessed the utilization and completeness of 'Hyposcreen' investigations and individual biochemical tests.
Main Results:
- Only 41% of patients required 'Hyposcreen' investigation; of those, only 2 of 23 completed the investigation.
- Commonly performed tests included intermediary metabolites, lactate, cortisol, and insulin, while urine samples and ammonia were least common.
- Abnormal results were frequent (affecting 10 patients), but only 5 had follow-up. Significant unnecessary expenditure (£1630 identified) was incurred.
Conclusions:
- Paediatric hypoglycaemia investigations are frequently incomplete (91%) or inappropriate (21%), resulting in substantial financial waste.
- Inadequate or incorrect investigations can delay diagnosis and impact patient care.
- There is a need for national, evidence-based guidelines on investigation thresholds and normal ranges for paediatric hypoglycaemia.