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Paediatric hypoglycaemia; are we investigating appropriately and adequately?
  1. Louise Ramsden1,
  2. Katherine Wright2,
  3. Anuja Natarajan2
  1. 1Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
  2. 2Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, South Yorkshire, UK
  1. Correspondence to Dr Anuja Natarajan, Doncaster and Bassetlaw Hospitals NHS Foundation Trust, Thorne Road, Doncaster, South Yorkshire DN2 5LT, UK; Anuja.Natarajan{at}dbh.nhs.uk

Abstract

Introduction Paediatric hypoglycaemia is a relatively common medical emergency. To allow identification of the underlying cause, investigations need to be performed urgently prior to treatment being given. Careful consideration is needed to ensure correct patient selection, as inadequate investigations have further cost and patient safety implications.

Methods 49 cases of proven or suspected hypoglycaemia (glucose ≤2.6 mmol/L) were identified via the laboratory. Clinical notes, laboratory investigations and results were reviewed.

Results Only 41% of patients (15 neonates, 5 children) required investigation with a ‘Hyposcreen’. Of these 20 patients, 3 had no investigations performed. In the remaining patients the cause for hypoglycaemia was identifiable, but 6 had investigations regardless. In total 23 patients had ‘Hyposcreen’ but only 2 were complete. Intermediary metabolites (96%), lactate (100%), cortisol (100%), insulin (83%) and growth hormone (87%) were taken most commonly with urine samples (52%) and ammonia (30%) taken least often. 40% cortisol, 29% insulin and 56% intermediary metabolite results were abnormal affecting 10 patients, but only 5 had follow-up. A total of £6977 was spent on investigations, of which £1630 has subsequently been found to be unnecessary. If investigations in the 23 children had been complete, this would have totalled £2700 of unnecessary expenditure.

Conclusions Investigations for hypoglycaemia are generally incomplete (91%) or inappropriate (21%). This has major cost implications for both the National Health Service and the individual who is investigated inadequately or incorrectly. We need national evidence-based guidance for investigation thresholds and normal ranges to help avoid inappropriate investigations and delay in diagnosis.

  • AUDIT
  • HEALTH ECONOMICS

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Footnotes

  • Contributors LR completed data collection, review of clinical notes and was the main contributing author. AN was the main project supervisor and contributed to data review and editing of the main article. KW identified investigation of paediatric hypoglycaemia as an area of concern and initiated data collection and review.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Anonymised data regarding all subjects included in this audit are available. Please contact the corresponding author for further information.

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