Peffer J, McLaughlin C. 13(4). 34 - 39. (Journal Article)
Background: Hyperglycemia is often treated in both acute and long-term settings and has recently garnered attention for its utility as a prognostic marker in traumatic injury. This could be of vital importance in Special Operations, as triage and disposition of trauma patients are often accomplished under less-than-ideal conditions. Blood glucose levels are easily obtained, require inexpensive instruments, but are likely not routinely taken in the field for trauma patients. Objective: The objective of this review was to systematically search available medical literature for early (within 48 hours of presentation) hyperglycemia in trauma patients and present the relevant data regarding prognosis in a qualitative fashion. Sources: A systematic review was conducted of published Englishlanguage articles using PubMed/MEDLINE in addition to searching bibliographies. Search terms included hyperglycemia, trauma, and prognosis. Study Eligibility Criteria: Eligible analytical studies had an adult population, who had experienced a traumatic injury, with blood glucose measurements within the first 48 hours of care, and had prognostic end points such as morbidity measures (intensive care unit time, infection, length of stay, etc.) and/or mortality. Study Appraisal and Synthesis Methods: Studies were appraised according to their design, size, population characteristics, definition of "hyperglycemic" and "normoglycemic," and morbidity and mortality outcomes. Results: We reviewed 104 studies. Ninety-five were identified from a PubMed/MEDLINE search, and an additional nine were from relevant citations and bibliographies. Eighty-seven studies were excluded; 17 articles met inclusion criteria and were analyzed for the review. Five were prospective in nature and 12 were retrospective reviews. Five studies analyzed patients with traumatic brain injury, and one study exclusively concerned burn patients. Sixteen of the studies found negative outcomes with early hyperglycemia. One study found no significant relationship between serum glucose measurements and mortality. Limitations: Limitations of this review included the use of one database and articles available online and in English. Conclusions and Implications of Key Findings: There is strong evidence that early hyperglycemia is correlated with a worse prognosis in trauma patients. Providers at all levels could potentially use this information to aid in the triage and disposition of traumatic injury victims.
Keywords: trauma; hyperglycemia; prognosis; mortality