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Abstract
To develop a safe but less invasive approach to the investigation and management of hypoglycaemia in infants and children.
Methods 2010 We performed an audit of all hypoglycaemia screens undertaken between 1st February-12th May in a large district general hospital using retrospective case-note analysis.
Using these results we conducted a consultation exercise involving local consultants, biochemists and a tertiary metabolic specialist to develop a simple screening pathway that was also in line with the National Metabolic Biochemistry Network (NMBN) guidelines for investigation and management of hypoglycaemia. The pathway emphasises that symptomatic hypoglycaemia is a clinical emergency and permanent brain damage is a risk if treatment is delayed.
Table 1: 1st February 2011: The screening pathway was introduced into clinical practise
Table 2: 2011 & 2012: Re-audit of clinical practise in both years for the same time period (1st February- 12th May)
Results In 2010, 22 hypoglycaemia screens were performed, all of which were normal, except for a recurrent finding of mildly elevated 3 hydroxy-butyrylcarnitine (as would be expected during fasting). 19 sets of case-notes were obtained. These showed 18/19 children had gastroenteritis, 17/19 had no significant past medical history and 16/19 were admitted.
In 2011 and 2012 there was a substantial reduction in the number of screens performed in infants and children (10 in 2011; 7 in 2012). No significant abnormalities have been identified. The admission and follow up data for 2011 & 2012 is currently being analysed.
Total numbers of infants and children referred to hospital, and the proportion of children diagnosed with gastroenteritis were similar in all three years.
Conclusions Analysis of practise in 2010 highlighted a population of previously well children who presented with symptoms of gastroenteritis and were incidentally found to have hypoglycaemia and were therefore investigated accordingly.
We introduced a simple screening pathway for infants and children found to have hypoglycaemia. This approach remains in line with NMBN guidance.
It has resulted in >50% reduction in hypoglycaemia screens performed. The cost savings are based upon reduced numbers of hypoglycaemia screens (£214), overnight admissions (£380/nt) and follow-up (£226).
The findings suggest that it may be possible to further refine our approach thereby reducing the number of hypoglycaemia screens performed without compromising patient safety.