|Tight Glycemic Control In Critcally Injured Trauma Patients|
|Thomas Scalea, Kelly Bochicchio*, Steven Johnson, Anne Pyle*, Manjari Joshi*, Grant Bochicchio* |
University of Maryland, Baltimore, MD
|OBJECTIVE(S): Evaluate the impact of a tight glycemic control (TGC) protocol during the first week of admission in critically injured trauma patients|
METHODS: A prospective quasi-experimental interrupted time-series design was used to evaluate the impact of TGC (24 month pre-intervention phase (no TGC) vs. 24 month post intervention phase). Patients were stratified by serum glucose level on day 1-7 (low = 0-139 mg/dl, medium- high = 140-219 mg/dl, and high = >220 mg/dl), age gender and injury severity. Patients were further stratified by pattern of glucose control (all low, all medium high, all high, improving, worsening, highly variable). Outcome was measured by ventilator days, infection, hospital (HLOS) and ICU (ILOS) length of stay and mortality.
RESULTS: 1021 patients were evaluated in the pre-intervention phase as compared to 1108 patients in the post-intervention phase. There was no significant difference in mechanism (83% vs. 84% blunt), gender (74% vs. 73% male), age (44 vs 43 years) and ISS (26 vs.25). The TGC group was more likely to be in the all low pattern of glucose control (p<0.001). Incidence of infection significantly decreased (over the first 2 weeks) from 29% to 21% in the TGC group (p<0.001). Ventilator days [OR =3.9, 1.8,8.1], ILOS [OR = 4.3, 2.1,7.5] and HLOS [OR = 5.5, 2.2,11]and mortality [OR = 1.4, 1.1,10] were significantly higher in the non-TGC group when controlled for age, ISS, obesity and IDDM (p<0.01).
CONCLUSIONS: Positive outcomes associated with implementation of a TGC protocol necessitates further evaluation in a randomized prospective trial.
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