title: Hospitalization and discharge education of emergency department patients with hypoglycemia.
abstract: The purpose of this study is to evaluate the content and adequacy of emergency department (ED) discharge instructions and factors associated with hospitalization in patients presenting with hypoglycemia.
  
  
  
  This is a retrospective cohort study at 3 adult EDs. A 1-year consecutive sample of hypoglycemia cases were identified using ICD-9-CM codes and were confirmed by chart review. Clinical variables and written discharge instructions were analyzed by chart abstraction.
  
  
  
  Six hundred thirty-six charts of patients with possible hypoglycemia were reviewed, of which 436 (64%) hypoglycemia cases were confirmed. The median age was 64. Hypoglycemia was associated with sulfonylurea use for 78 (16%) patients and insulin alone for 286 (65%) patients. Written discharge instructions advised frequent blood glucose checks in 21% of patients and medication dose adjustment in 27% of patients and rarely recommended avoiding recurrent hypoglycemia (3%), checking glucose before driving (0.4%), or obtaining glucagon emergency kits (2%). Hospitalization resulted from 177 (41%) visits and was associated with older age (age 65-74 [odds ratio 5.7] and age >or=75 [odds ratio 7.9]), sulfonylurea use (odds ratio 3.5), >or=3 hypoglycemic episodes (odds ratio 3.1), no documented diabetes medications (odds ratio 2.1), current primary care provider (odds ratio 4.2), and hypoglycemia as a secondary diagnosis (odds ratio 4.7).
  
  
  
  ED written discharge instructions appeared inadequate in providing recommended education for patients with severe hypoglycemia. Older age and sulfonylurea use were independently associated with hospital admission. Although hypoglycemia is generally considered a self-limited condition, 2 of every 5 patients required hospitalization, which likely reflects an older and more complex patient population.
authors.affiliation: The Department of Emergency Medicine, University of Colorado Health Sciences Center, Aurora, Colorado (Dr Ginde)|Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Ginde)
authors.forename: Adit A
authors.initials: AA
authors.lastname: Ginde
authors.affiliation: Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts (Dr Pallin)
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Pallin
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts (Dr Camargo)
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000534:rehabilitation; D007004:Hypoglycemic Agents / Q000009:adverse effects; D007328:Insulin / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin