Victoria Miles, MD
University of Tennessee College of Medicine Chattanooga
Chattanooga, Tennessee
Disclosure information not submitted.
Kevin Friedrich, MD
General Surgery Resident
University of Tennessee College of Medicine Chattanooga, United States
Disclosure information not submitted.
Hunter Rooks, MD
General Surgery Resident
University of Tennessee College of Medicine Chattanooga, United States
Disclosure information not submitted.
Hunter Parmer, MD
General Surgery Resident
University of Tennessee College of Medicine Chattanooga, United States
Disclosure information not submitted.
Cassidy Clark, MD
Medical Student
University of Tennessee School of Medicine, United States
Disclosure information not submitted.
Lani Gao, PhD
Statistician
University of Tennessee Chattanooga Department of Mathematics, United States
Disclosure information not submitted.
Vicente Mejia, MD, FACS
Trauma and Acute Care Surgeon
University of Tennessee College of Medicine Chattanooga, United States
Disclosure information not submitted.
Title: Stress Hyperglycemia, Not Diabetes, is Associated with Increased Mortality and Ventilation in Trauma
Introduction: The current prevalence of diabetes mellitus (DM) in the US is estimated to be 12-14% of adults, and approximately 25% of those individuals remain undiagnosed. Diabetic trauma patients are reported to experience worse outcomes: increased hospital length of stay (LOS), ventilator days, infectious complications, and mortality. A link between elevated blood glucose and trauma has been demonstrated and termed stress hyperglycemia (SH). For this study, outcomes were compared for trauma patients with DM (HbA1c ≥ 6.5%) and SH. We hypothesized patients with DM, not SH, would experience worse outcomes.
Methods: A retrospective review was conducted at a level 1 trauma center of all hyperglycemic (glucose > 100 mg/dL) patients admitted to the trauma service from December 2019 to November 2020. Hemoglobin A1c (HbA1c) testing was obtained on the entire cohort. Trauma patients found to be hyperglycemic were treated with sliding scale insulin every 4 hours per trauma service protocol. Data was collected and analyzed.
Results: A total of 418 patients with glucose > 100 mg/dL on arrival were included in the study. Of those, 106 were found to have elevated HbA1c ≥ 6.5%, including those previously diagnosed with DM, and 312 were diagnosed with SH and had HbA1c < 6.5%. Compared to patients with DM, SH patients were noted to be younger (mean age 49.50 vs 64.07), more likely male (68.59% vs 55.66%), and to have a lower BMI (27.27 vs 31.99); ISS did not differ. When compared, mortality (p=0.0386) was increased and ventilatory requirement (p=0.0585) trended to increase in SH as compared to DM. No difference was observed in hospital/ICU LOS, total transfusion volume, admit lactate, need for surgery, new-onset arrhythmia, acute renal failure, nor infectious/renal/pulmonary complications. Of the 418-patient cohort undergoing HbA1c testing, 17 (4.07%) were diagnosed with occult DM and referred to medicine; 42 (10.05%) were warned of their pre-diabetes condition (HbA1c ranging 5.7-6.4%).
Conclusion: Obtaining HbA1c testing in hyperglycemic trauma patients identifies patients with occult DM and allows for appropriate referral for medical management. Additionally, SH is common in trauma and associated with increased mortality and ventilatory requirement. Appropriately treating SH may prove integral to improving trauma patient outcomes.