title: Prehospital Glucose Testing for Children with Seizures: A Proposed Change in Management.
abstract: Many Emergency Medicine Services (EMS) protocols require point-of-care blood glucose testing (BGT) for any pediatric patient who presents with seizure or altered level of conscious. Few data describe the diagnostic yield of BGT when performed on all pediatric seizures regardless of presenting mental status. We analyzed a large single center dataset of pediatric patients presenting with prehospital seizures to determine the prevalence of hypoglycemic seizures and the utility of repeat BGT in the emergency department (ED).
  
  
  
  This was a retrospective, IRB-approved chart analysis of all pediatric patients (≤14 years) transported by EMS to the Harbor-UCLA pediatric ED over a 2-year period with a chief complaint of seizure. Cases were selected in which witnessed seizures had occurred in the field by family or EMS. Chart review included prehospital, nursing and physician records. Hypoglycemia was defined as blood glucose <60 mg/dL. Analysis included blood glucose, witnessed field seizure, initial mental status assessed by Glasgow Coma Scale (GCS), and further mental status assessments, along with age, sex, and medical history. Medical records were reviewed for subsequent BGT and patient outcome.
  
  
  
  A total 770 children were transported by EMS due to seizures. Four patients (0.5%) had recorded hypoglycemia in the field, yet only two received treatment to raise blood glucose. Additionally, one child (0.1%) was normoglycemic (81 mg/dL) in the field with hypoglycemia (43 mg/dL) in the ED but required no intervention. Two were found by EMS to have an ALOC (GCS ≤ 12) and hypoglycemia. Only the patient with hypoglycemia secondary to a suspected glipizide ingestion received ED glucose administration. The most common discharge diagnosis was simple febrile seizure (38.6%).
  
  
  
  Hypoglycemia in the pediatric seizure patient is extremely rare, thus universal field BGT has low utility and potential downstream effects. We propose a novel algorithm for the initial evaluation and management of prehospital pediatric seizures. Although limited to a retrospective analysis of a single medical center, our findings suggest the importance of reassessing prehospital seizure protocols. A larger patient sample should be studied to validate these findings and identify unique cases where glucose testing might be useful.
authors.forename: Katherine
authors.initials: K
authors.lastname: Remick
authors.forename: Christopher
authors.initials: C
authors.lastname: Redgate
authors.forename: Daniel
authors.initials: D
authors.lastname: Ostermayer
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kaji
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
mesh_terms: D000465:Algorithms; D001786:Blood Glucose / Q000032:analysis*; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards*; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D007223:Infant; D008297:Male; D019095:Point-of-Care Systems; D012189:Retrospective Studies; D012640:Seizures / Q000097:blood / Q000209:etiology / Q000628:therapy*
chemical_list: D001786:Blood Glucose
keywords: assessment; glucose; pediatric; prehospital; seizure