ESPE Abstracts

Background: Hypoglycemia in children is common but can indicate serious underlying conditions. Previous research has shown low rates of complete diagnostic evaluations for hypoglycemia in pediatric emergency rooms. This may be due to the complexity and time-consuming nature of the required workup and a lack of knowledge about the incidence of serious hypoglycemic disorders in children. This study aims to assess the effectiveness of an intervention to improve the investigation of hypoglycemia in a pediatric emergency room and evaluate related background factors and their impact on investigation and diagnosis.

Methods: This retrospective study collected data from the medical records of children aged 0-18 who presented with hypoglycemia at the pediatric emergency department of Shaare Zedek Medical Center in Jerusalem between March 2020 and February 2023. The study group included children seen after an intervention to improve hypoglycemia management, while the control group included those seen before the intervention. The intervention involved simplifying the workup procedure and creating and disseminating a clear management protocol for hypoglycemia. Background data, clinical variable and laboratory test values were extracted from patient records.

Resuls: The study included 165 children: 86 in the study group and 79 in the control group. Overall, 44% of the children in both groups did not undergo any investigation, and 17.5% underwent a complete investigation. Following the intervention, 22.1% of children underwent a complete investigation compared to 12.7% before the intervention (P value = 0.08). The percentage of partial investigations decreased after the intervention from 44% to 32%, while the percentage of children who did not undergo any investigation remained similar (43% before vs. 45.3% after). A lower blood glucose level at ED presentation and the presence of seizures were significantly associated with a complete investigation. In the group that underwent a complete investigation, a diagnosis explaining hypoglycemia was found in 20.7% (6/29 children). Significant associations were found between reaching a diagnosis and younger age, previous hypoglycemic episodes, drowsiness, seizures, and low glucose levels at presentation.

Conclusion: The study indicates a trend toward improved investigation of hypoglycemia in children in the pediatric ED after the intervention, with increased rates of complete versus partial investigations. However, the intervention did not change the overall percentage of children undergoing any investigation. Even with simplified procedures, barriers to hypoglycemia investigations persist, likely due to clinician decision-making processes. Further studies should examine this process and the long-term implications of inadequate investigation of hypoglycemia in the ED.