Is prehospital blood glucose measurement necessary in suspected cerebrovascular accident patients?

The present study was completed to establish an epidemiologic database defining prehospital management of suspected cerebrovascular accidents (CVAs) with attention to blood glucose measurement, in the hope of developing recommendations for further treatment protocols. On review of 9495 paramedic run reports for the 24-month period from January 2001 through December 2002, from a low-volume urban emergency medical services system, 185 persons presented with CVA signs and/or symptoms. Data collected included patient chief complaint, neurologic examination, patient age, vital signs, ambulance field times, patient past medical history, and blood glucose measurement with resulting prehospital interventions, efficacy of interventions, and iatrogenic complications. Five persons (2.70%), all medication-controlled diabetics, were found to be hypoglycemic. After administration of intravenous dextrose 50% by rescue personnel, improvement in neurologic condition was noted in 100% of these cases. No sequelae as a result of such care occurred. No inappropriate use, point estimate ([0]/[5][0.00%-52.20%]), or unmet need, point estimate ([0]/[9495][0.00%-0.04%]), of care was noted. The data presented in this study suggest that given similar emergency medical service system characteristics, hypoglycemic patients presenting with neurologic deficits suggestive of CVAs constitute a rare event, associated with medical histories predictive of problems involving glucose homeostasis. Blood glucose measurement in persons presenting with CVA signs and/or symptoms is only necessary given the presence of history suspicious for hypoglycemia, or rescuer inability to obtain adequate patient information. Routine prehospital blood glucose measurement in patients with suspected CVA appears unnecessary.