title: Out-of-hospital treatment of hypoglycemia: refusal of transport and patient outcome.
abstract: OBJECTIVE
  Patient refusal of transport after treatment of hypoglycemia is common in urban emergency medical services (EMS) systems. The rate of relapse is unknown. The goal of this study was to compare the outcomes of diabetic patients initially refusing transport (refusers) and those transported to an ED.
  
  
  METHODS
  All paramedic runs from January to July 1995 were retrospectively reviewed. Inclusion criteria were adult patients with a field assessment of hypoglycemic signs/symptoms, and a fingerstick glucose <80 mg/dL. Data for analysis included paramedic run duration, patient demographics, and refusal or acceptance of transport. Patient outcome was obtained from a review of hospital and medical examiner records. Relapse was defined as hypoglycemia necessitating EMS activation or an ED visit within 48 hours of the initial episode. Student's t-test and chi2 analysis were used to compare means and 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 patients (27.8%). The hospital records of 4 transported patients were unavailable. Sixty-three transported patients were admitted (11.2%), with 1 death from prolonged hypoglycemia. The rates of relapse did not differ between the refusers and the transported patients (p > 0.05). Twenty-five relapses occurred among the refusers (6.1%), with 14 repeat refusals, 11 transports, 5 admissions, and no deaths. There were 7 relapses among the transported patients (4.4%), with 2 refusals, 5 transports, 2 admissions, and no deaths. The paramedic run time was significantly shorter for the refusers than for the transported patients (p < 0.05).
  
  
  CONCLUSIONS
  The out-of-hospital treatment of hypoglycemic diabetic patients appears to be effective and efficient. Independent of the patient's refusal or acceptance of transport, the out-of-hospital treatment of hypoglycemic patients in this system appears to be safe.
authors.affiliation: Department of Emergency Medicine, Sudbury Regional Hospital, ON, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: Socransky
authors.forename: R G
authors.initials: RG
authors.lastname: Pirrallo
authors.forename: J M
authors.initials: JM
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000488:Allied Health Personnel; D003920:Diabetes Mellitus; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D016312:Treatment Refusal; D014505:Urban Population; D014922:Wisconsin