Abstract
This was a retrospective study of pediatric trauma patients and were hospitalized in a level-1 trauma center from January 1, 2009 to December 31, 2016. Stress-induced hyperglycemia (SIH) was defined as a hyperglycemia level ≥200 mg/dL upon arrival at the emergency department without any history of diabetes or a hemoglobin A1c level ≥6.5% upon arrival or during the first month of admission. The results demonstrated that the patients with SIH (n = 36) had a significantly longer length of stay (LOS) in hospital (16.4 vs. 7.8 days, p = 0.002), higher rates of intensive care unit (ICU) admission (55.6% vs. 20.9%, p < 0.001), and higher in-hospital mortality rates (5.6% vs. 0.6%, p = 0.028) compared with those with non-diabetic normoglycemia (NDN). However, in the 24-pair well-balanced propensity score-matched patient populations, in which significant difference in sex, age, and injury severity score were eliminated, patient outcomes in terms of LOS in hospital, rate of ICU admission, and in-hospital mortality rate were not significantly different between the patients with SIH and NDN. The different baseline characteristics of the patients, particularly injury severity, may be associated with poorer outcomes in pediatric trauma patients with SIH compared with those with NDN. This study also indicated that, upon major trauma, the response of pediatric patients with SIH is different from that of adult patients.
Highlights
Hyperglycemia is defined as serum glucose level >200 mg/dL
The patients were diagnosed with hyperglycemia if they presented with serum glucose level ≥200 mg/dL upon arrival to the emergency department (ED) based on the current criteria of the American Diabetes Association[20], and Stress-induced hyperglycemia (SIH) was defined as the presence of hyperglycemia without any history of diabetes or hemoglobin A1c (HbA1c) level ≥6.5% upon arrival or during the first month of admission[15,16,17]
This study revealed that the pediatric trauma patients who presented with SIH had a significantly poor outcome than those with non-diabetic normoglycemia (NDN)
Summary
Hyperglycemia is defined as serum glucose level >200 mg/dL. A positive correlation was observed between hyperglycemia upon admission and poor outcome in patients with trauma[1,2,3,4]. The hemodynamic response was described in the literature as a combination of high plasma catecholamine levels, increased sympathetic activity, and increased cortisol levels that regulate cardiac output, blood pressure, and end-organ perfusion[6,8,9]. These mechanisms may alter carbohydrate metabolism, which include increased gluconeogenesis, depressed glycogenesis, glucose intolerance, and insulin resistance, as a result of decreased glucose uptake in the skeletal muscle[10,11]. In this study, we aimed to assess the impact of SIH compared with NDN on the outcomes of pediatric patients with trauma in the selected propensity-score-matched patient population. This study primarily hypothesized that patients with SIH had a worse outcome than those with NDN
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