EBQ:Relevance of Discharge Glucose Levels - Revision history

Danbot: Added funding section

2026-03-21T22:35:25Z

Added funding section

← Older revision		Revision as of 22:35, 21 March 2026
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	*Potential outcome bias, based upon the fact that patients may seek care in outside network hospitals and systems, which would not allow for the true 7 day outcomes to be measured		*Potential outcome bias, based upon the fact that patients may seek care in outside network hospitals and systems, which would not allow for the true 7 day outcomes to be measured

			==Funding==
			*None reported

	==External Links==		==External Links==
	*[http://rebelem.com/mythbuster-glucose-levels-must-be-below-a-safe-threshold-before-discharge/ RebelEM - Mythbuster: Glucose Levels Must Be Below a "Safe" Level at Discharge]		*[http://rebelem.com/mythbuster-glucose-levels-must-be-below-a-safe-threshold-before-discharge/ RebelEM - Mythbuster: Glucose Levels Must Be Below a "Safe" Level at Discharge]

Rossdonaldson1: /* See Also */

2017-02-01T12:19:06Z

MMarschall: Under Review JC

2017-01-27T03:10:23Z

Under Review JC

← Older revision		Revision as of 03:10, 27 January 2017
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	\| fulltexturl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/abstract		\| fulltexturl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/abstract
	\| pdfurl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/pdf		\| pdfurl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/pdf
			\| status=Under Review
	}}		}}
	==Clinical Question==		==Clinical Question==
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	* [[Hyperosmolar hyperglycemic state]]		* [[Hyperosmolar hyperglycemic state]]

	[[Category:EBQ~~]] [[Category: Incomplete Journal Club Article~~]]		[[Category:EBQ]]

MMarschall at 03:07, 27 January 2017

2017-01-27T03:07:33Z

← Older revision		Revision as of 03:07, 27 January 2017
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	==Conclusion==		==Conclusion==
	Higher discharge glucose levels were ~~'''~~not~~'''~~ associated with a greater risk of repeated ED visits, hospitalization, or other adverse outcomes.		'''Higher discharge glucose levels were not associated with a greater risk of repeated ED visits, hospitalization, or other adverse outcomes.'''

	==Major Points==		==Major Points==

MMarschall: Outcomes, Journal Club

2017-01-27T03:03:08Z

Outcomes, Journal Club

← Older revision		Revision as of 03:03, 27 January 2017
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	==Outcomes==		==Outcomes==
			*With 13% of patients lost to follow up, 495 encounters remained for analysis.
			*Mean discharge glucose in analyzed patients ranged from 48-694.

	===Primary Outcome===		===Primary Outcome===
			The Primary Outcome looked to determine if there was an association between discharge glucose and 7 day adverse outcomes (return ED visit for hyperglycemia, or hospitalization).
			*Return ED visits for hyperglycemia: 13% of patients (n=62)
			*Patients requiring hospitalization: 7% (n=36)
			*DKA was rare, occurring in only 2 patients
			*No deaths were observed

			*'''Mean discharge glucose for patients WITH and WITHOUT 7 day adverse events was 317 mg/dL and 336 mg/dL respectively.''' After adjusting for confounders, no associated between discharge glucose and repeat ED visit or hospitalization was seen.

	===Secondary Outcomes===		===Secondary Outcomes===
			A secondary dichotomous variable model was constructed to evaluate if a discharge glucose level greater than 350 mg/dL was associated with greater 7 day adverse effects; no such affect was determined.


	~~===Subgroup analysis===~~



	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==

MMarschall: JC edit

2017-01-27T02:43:20Z

JC edit

← Older revision		Revision as of 02:43, 27 January 2017
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	*those known to be Type I diabetics		*those known to be Type I diabetics
	*if the chief complaint was hypoglycemia		*if the chief complaint was hypoglycemia
	==Interventions==		==Interventions==
			No specific interventions were mandated in the study, and the outcomes were compared to discharge glucose absolute values, not interventions. However, the authors did include information on interventions taken to lower glucose levels while in the ED. Specifically:

			*60% of patients received both IV fluids and SubQ insulin
			*12% of patients received neither IV fluids or insulin.

	==Outcomes==		==Outcomes==

MMarschall: Journal Club

2017-01-13T23:12:58Z

Journal Club

← Older revision		Revision as of 23:12, 13 January 2017
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	==Major Points==		==Major Points==
			Elevated blood glucose levels have long been known to be associated poor long term outcomes, as well as short term complications of critically ill and hospitalized patients. ED physicians, however, have long struggled with the appropriate management of moderate-severe hyperglycemia in patients appropriate to discharge from the ED. Up to this point, there are no guidelines for a "safe" discharge glucose level, or if the finding is associated with significant short term adverse outcomes. In this retrospective chart review, the authors looked at Type II diabetics with glucose readings > 400 and discharged from the ED, and sought to verify if there was an association between higher glucose levels and poor 7 day outcomes. The authors concluded that no association exists, and that attaining a specific glucose level prior to discharge in patients not requiring admission is likely less important that previously thought.

	==Study Design==		==Study Design==
			This was a retrospective cohort chart review that searched for patients with glucose levels > 400 and discharged from the ED. Outcome measures were obtained by again searching the electronic records within the study network, as well as ambulance registry. The study took place at an urban Level I trauma center with an average ED census of 100,000 patients. The study took place from January 1, 2010 through December 31, 2011.

	==Population==		==Population==
	===Patient Demographics===		===Patient Demographics===
			* 58% men, 42% women
			*Mean age = 46
			*Most common chief complaint was hyperglycemia (49%), followed by alcohol intoxication (11%)
			*Mean arrival glucose = 491

	===Inclusion Criteria===		===Inclusion Criteria===
			All patients who were over the age of 18 and had a glucose reading at any type of 400 or greater were evaluated for inclusion.

	===Exclusion Criteria===		===Exclusion Criteria===
			The following patients were excluded from the study:
			*patients admitted to the hospital
			*those known to be Type I diabetics
			*if the chief complaint was hypoglycemia
	==Interventions==		==Interventions==

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	==Criticisms & Further Discussion==		==Criticisms & Further Discussion==
			*Type I diabetes were excluded from this study, so the results should not be applied to these patients
			*Retrospective
			*Potential outcome bias, based upon the fact that patients may seek care in outside network hospitals and systems, which would not allow for the true 7 day outcomes to be measured

	==External Links==		==External Links==
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	* [[Diabetic ketoacidosis]]		* [[Diabetic ketoacidosis]]
	* [[Hyperosmolar hyperglycemic state]]		* [[Hyperosmolar hyperglycemic state]]

	~~==Funding==~~

	~~==References==~~
	~~<references/>~~

	[[Category:EBQ]] [[Category: Incomplete Journal Club Article]]		[[Category:EBQ]] [[Category: Incomplete Journal Club Article]]

MMarschall: Journal Club

2017-01-13T22:36:49Z

Journal Club

← Older revision		Revision as of 22:36, 13 January 2017
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	==See Also==		==See Also==
			* [[Diabetes mellitus (main)]]
			* [[Diabetic ketoacidosis]]
			* [[Hyperosmolar hyperglycemic state]]

	==Funding==		==Funding==

MMarschall: New Article

2017-01-13T00:49:24Z

New Article

New page

{{JC info
| title= Discharge Glucose is Not Associated With Short-Term Adverse Outcomes in Emergency Department Patients With Moderate to Severe Hyperglycemia
| abbreviation=
| expansion=
| published= 2016
| author= Driver B, Olives T, Bischof J, Salmon M, Miner J
| journal= Annals of Emergency Medicine
| year= 2016
| volume= 68
| issue= 6
| pages= 697-705
| pmid= 27353284
| fulltexturl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/abstract
| pdfurl= http://www.annemergmed.com/article/S0196-0644(16)30162-7/pdf
}}
==Clinical Question==
Is the ED discharge glucose level associated with adverse outcomes?

==Conclusion==
Higher discharge glucose levels were '''not''' associated with a greater risk of repeated ED visits, hospitalization, or other adverse outcomes.

==Major Points==

==Study Design==

==Population==
===Patient Demographics===
===Inclusion Criteria===

===Exclusion Criteria===

==Interventions==

==Outcomes==

===Primary Outcome===

===Secondary Outcomes===

===Subgroup analysis===

==Criticisms & Further Discussion==

==External Links==
*[http://rebelem.com/mythbuster-glucose-levels-must-be-below-a-safe-threshold-before-discharge/ RebelEM - Mythbuster: Glucose Levels Must Be Below a "Safe" Level at Discharge]
*[https://coreem.net/journal-reviews/discharge-glucose-levels/ CoreEM - Relevance of Discharge Glucose Levels and Adverse Events]

==See Also==

==Funding==

==References==
<references/>

[[Category:EBQ]] [[Category: Incomplete Journal Club Article]]

← Older revision		Revision as of 12:19, 1 February 2017
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	==See Also==		==See Also==
	* [[Diabetes mellitus (main)]]		* [[Diabetes mellitus (main)]]
	* [[~~Diabetic ketoacidosis]]~~		* [[Nonketotic hyperglycemia]]
	* [[Hyperosmolar hyperglycemic state]]

	[[Category:EBQ]]		[[Category:EBQ]]