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An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia

BACKGROUND: The Glasgow Coma Scale (GCS) score of an individual with hypoglycemia is expected to be low due to an insufficient glucose supply to the brain. However, we sometimes encounter hypoglycemic patients with high GCS scores. This study was undertaken to analyze the relationship between the GC...

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Autores principales: Kotera, Atsushi, Iwashita, Shinsuke, Irie, Hiroki, Taniguchi, Junichi, Kasaoka, Shunji, Kinoshita, Yoshihiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267581/
https://www.ncbi.nlm.nih.gov/pubmed/25520819
http://dx.doi.org/10.1186/2052-0492-2-1
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author Kotera, Atsushi
Iwashita, Shinsuke
Irie, Hiroki
Taniguchi, Junichi
Kasaoka, Shunji
Kinoshita, Yoshihiro
author_facet Kotera, Atsushi
Iwashita, Shinsuke
Irie, Hiroki
Taniguchi, Junichi
Kasaoka, Shunji
Kinoshita, Yoshihiro
author_sort Kotera, Atsushi
collection PubMed
description BACKGROUND: The Glasgow Coma Scale (GCS) score of an individual with hypoglycemia is expected to be low due to an insufficient glucose supply to the brain. However, we sometimes encounter hypoglycemic patients with high GCS scores. This study was undertaken to analyze the relationship between the GCS score and the plasma glucose level. METHODS: Among the patients with neurological impairments admitted to our institution between October 1, 2010 and March 31, 2013, the cases of 41 hypoglycemic patients were examined in this retrospective cohort study. The defined plasma glucose level for mild hypoglycemia was 41–60 mg/dL, that for moderate hypoglycemia was 21–40 mg/dL, and that for extreme hypoglycemia was below 20 mg/dL. We divided the patients into two groups: those with mild hypoglycemia (n = 14) and those with moderate/extreme hypoglycemia (n = 27). We compared the two groups' physiological data and assessed the relationship between the GCS score and the plasma glucose level by Spearman rank correlation (ρ), the significance of which was determined by Spearman's rank sum test. We used the Mann-Whitney U-test and the chi-square (χ(2)) test to test for differences between the two groups when appropriate. RESULTS: Three hundred twenty-six patients with neurological impairments were admitted during the study period, and 41were eligible hypoglycemic patients. The GCS scores of the 14 patients with mild hypoglycemia were significantly higher than those of the 27 patients with moderate or extreme hypoglycemia (median score 12, range 7–15 vs. 10, 3–15, p = 0.0367). There were no significant differences in physiological data (including autonomic symptoms) between the two groups. Spearman's rank sum test was 0.491 in the total group of 41 hypoglycemic patients, 0.053 in the mild hypoglycemic patients, and 0.493 in the moderately or extremely hypoglycemic patients. CONCLUSIONS: The relationship between the GCS score and the plasma glucose level differed according to the severity of hypoglycemia. Even when a patient has a high GCS score, careful assessment of differential diagnosis should be conducted and the possibility of hypoglycemia should be considered in light of his or her neurogenous symptoms.
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spelling pubmed-42675812014-12-17 An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia Kotera, Atsushi Iwashita, Shinsuke Irie, Hiroki Taniguchi, Junichi Kasaoka, Shunji Kinoshita, Yoshihiro J Intensive Care Research BACKGROUND: The Glasgow Coma Scale (GCS) score of an individual with hypoglycemia is expected to be low due to an insufficient glucose supply to the brain. However, we sometimes encounter hypoglycemic patients with high GCS scores. This study was undertaken to analyze the relationship between the GCS score and the plasma glucose level. METHODS: Among the patients with neurological impairments admitted to our institution between October 1, 2010 and March 31, 2013, the cases of 41 hypoglycemic patients were examined in this retrospective cohort study. The defined plasma glucose level for mild hypoglycemia was 41–60 mg/dL, that for moderate hypoglycemia was 21–40 mg/dL, and that for extreme hypoglycemia was below 20 mg/dL. We divided the patients into two groups: those with mild hypoglycemia (n = 14) and those with moderate/extreme hypoglycemia (n = 27). We compared the two groups' physiological data and assessed the relationship between the GCS score and the plasma glucose level by Spearman rank correlation (ρ), the significance of which was determined by Spearman's rank sum test. We used the Mann-Whitney U-test and the chi-square (χ(2)) test to test for differences between the two groups when appropriate. RESULTS: Three hundred twenty-six patients with neurological impairments were admitted during the study period, and 41were eligible hypoglycemic patients. The GCS scores of the 14 patients with mild hypoglycemia were significantly higher than those of the 27 patients with moderate or extreme hypoglycemia (median score 12, range 7–15 vs. 10, 3–15, p = 0.0367). There were no significant differences in physiological data (including autonomic symptoms) between the two groups. Spearman's rank sum test was 0.491 in the total group of 41 hypoglycemic patients, 0.053 in the mild hypoglycemic patients, and 0.493 in the moderately or extremely hypoglycemic patients. CONCLUSIONS: The relationship between the GCS score and the plasma glucose level differed according to the severity of hypoglycemia. Even when a patient has a high GCS score, careful assessment of differential diagnosis should be conducted and the possibility of hypoglycemia should be considered in light of his or her neurogenous symptoms. BioMed Central 2014-01-03 /pmc/articles/PMC4267581/ /pubmed/25520819 http://dx.doi.org/10.1186/2052-0492-2-1 Text en © Kotera et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Kotera, Atsushi
Iwashita, Shinsuke
Irie, Hiroki
Taniguchi, Junichi
Kasaoka, Shunji
Kinoshita, Yoshihiro
An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title_full An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title_fullStr An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title_full_unstemmed An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title_short An analysis of the relationship between Glasgow Coma Scale score and plasma glucose level according to the severity of hypoglycemia
title_sort analysis of the relationship between glasgow coma scale score and plasma glucose level according to the severity of hypoglycemia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267581/
https://www.ncbi.nlm.nih.gov/pubmed/25520819
http://dx.doi.org/10.1186/2052-0492-2-1
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