The Glucose Connection: Field Hyperglycemia as an Early Predictor of Hypotension in Trauma Patients

Trauma is the fourth leading cause of death overall for all ages and identifying a preemptive surrogate parameter that indicates impending shock would allow for optimization of prehospital care.Stress induced hyperglycemia (SIH) occurs secondary to critical illness or injury. Research indicates that SIH is a predictor of mortality in critically ill patients. Multiple studies have indicated a positive correlation between admission hyperglycemia and hypotension in trauma patients. The purpose of this retrospective chart review study is to evaluate the utility of prehospital point of care glucose as an independent predictor of hypotension in the adult trauma patient.

The primary study objective was to determine if point of care glucose measurement during prehospital transport is predictive of hypotension (systolic blood pressure < 90 mmHg) prior to arrival at the receiving trauma center. A total of 107 patients met inclusion criteria. The primary analysis was a receiver operating characteristics curve, (ROC curve) for the blood glucose diagnostic for predicting hypotension outcome with 95% confidence for the area under the curve and non-parametric comparison to 0.5. The optimal diagnostic cutoff point was determined using Youden's J and 95% confidence intervals for sensitivity and specificity.

There were a total of 1623 trauma transports for the programs in 2018. Our final sample was 107 trauma patients. There were n=22 (20.6%) who had hypotensive systolic BP values (systolic BP < 90) upon arrival at the receiving facility. The ROC diagnostic determined that glucose >= 220 and had a 2.95 increased relative risk of hypotension if the patient's point of care glucose was >= 220. Patients with a glucose >= 220, the systolic blood pressure decreased an average of 13.5 mm Hg. A glucose < 220 demonstrated an increased systolic blood pressure of 0.26 mmHg.

In prehospital trauma patients, point of care glucose measurements greater than 220 predicted a nearly threefold increase in hypotension prior to arrival at the trauma center. Prehospital point of care glucose measurements are simple, rapid, and inexpensive and may help to identify those patients requiring aggressive resuscitation prior to arrival to the receiving trauma facility.