title: Paediatric hypoglycaemia; are we investigating appropriately and adequately?
abstract: BACKGROUND
  Paediatric hypoglycaemia is a relatively common medical emergency. To allow identification of the underlying cause, investigations need to be performed urgently prior to treatment being given. Careful consideration is needed to ensure correct patient selection, as inadequate investigations have further cost and patient safety implications.
  
  
  METHODS
  49 cases of proven or suspected hypoglycaemia (glucose ≤2.6 mmol/L) were identified via the laboratory. Clinical notes, laboratory investigations and results were reviewed.
  
  
  RESULTS
  Only 41% of patients (15 neonates, 5 children) required investigation with a 'Hyposcreen'. Of these 20 patients, 3 had no investigations performed. In the remaining patients the cause for hypoglycaemia was identifiable, but 6 had investigations regardless. In total 23 patients had 'Hyposcreen' but only 2 were complete. Intermediary metabolites (96%), lactate (100%), cortisol (100%), insulin (83%) and growth hormone (87%) were taken most commonly with urine samples (52%) and ammonia (30%) taken least often. 40% cortisol, 29% insulin and 56% intermediary metabolite results were abnormal affecting 10 patients, but only 5 had follow-up. A total of £6977 was spent on investigations, of which £1630 has subsequently been found to be unnecessary. If investigations in the 23 children had been complete, this would have totalled £2700 of unnecessary expenditure.
  
  
  CONCLUSIONS
  Investigations for hypoglycaemia are generally incomplete (91%) or inappropriate (21%). This has major cost implications for both the National Health Service and the individual who is investigated inadequately or incorrectly. We need national evidence-based guidance for investigation thresholds and normal ranges to help avoid inappropriate investigations and delay in diagnosis.
authors.affiliation: Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Ramsden
authors.affiliation: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Wright
authors.affiliation: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK.
authors.forename: Anuja
authors.initials: A
authors.lastname: Natarajan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male
keywords: AUDIT; HEALTH ECONOMICS