Stress Hyperglycemia Is Associated With Similar Mortality and Complication Rates Compared to Trauma Patients With...

Diabetes mellitus (DM) is one of the most common diseases worldwide and is a known significant cause of morbidity and mortality. Specifically, DM and stress-induced hyperglycemia (SH) significantly increase morbidity and mortality in trauma patients. It is currently unknown how complication rates compare between trauma patients with SH and DM as well the rate of undiagnosed diabetes in trauma patients.

The institutional review board at our institution reviewed and approved the following study. A practice management guideline was established calling for the collection of a hemoglobin A1c (HbA1c) on all trauma patients admitted with a blood glucose of >100 mg/dL. A retrospective review was performed on 417 trauma patients and were stratified into two groups: DM (elevated HbA1c with/without elevated SH ratio) or SH (elevated SH ratio only). Statistical analyses were then completed using the following data points: basic demographic data, hospitalization data, and complication rates.

A total of 417 patients underwent hemoglobin with A1c testing due to glucose of >100. Of these, 17 were excluded due to normal HbA1c and normal SH ratio. SH patients were noted to be younger, had a lower body mass index, had a lower admission Glasgow Coma Scale, had a higher injury severity score, and were more likely to require operative intervention on arrival (26.8% versus 15.0%; P = 0.01). Patients with DM were more likely to suffer from cardiovascular complications (11.5% versus 4.9%; P = 0.01); however, they suffered similar rates in mortality, hospital length of stay, intensive care unit length of stay, and other complications between the two groups. Of note, we were able to diagnose 19 patients with DM (4.5%) and 42 with pre-DM (10.0%) without a previous history of either disease.

SH patients tended to be sicker on arrival but overall suffered similar complication rates compared to patients with DM. Additionally, HbA1c is a feasible tool to screen for occult DM in trauma patients. Future areas of research will focus on implementing a similar practice management guideline for our emergency general surgery service.