Adrenal crisis is a life-threatening complication in patients with adrenal insufficiency. In order to prevent critical situations, patients are supposed to increase their glucocorticoid dose in distressing situations. If dose adjustment is not sufficient, sooner or later patients will fall into a coma, followed by death. While health condition worsens patients usually call paramedics, followed by a decision for primary therapy and transportation to the nearest hospital. We assessed whether paramedics and emergency physicians had ever suspected an acute adrenal crisis and initiated a steroid treatment in a preclinical setting. Furthermore, we wanted to know whether they feel confident in recognizing patients with acute adrenal crisis. To conclude, we asked them to estimate their respective need of further educational programs. We sent 1000 questionnaires to paramedics and emergency physicians in the region of Hanover containing questions about topics mentioned above. We received 19.6% (n=196) completed questionnaires of which 23% (n=46) were answered by emergency physicians and 68% by paramedics. All in all, questionnaires were answered by very experienced care givers with 70% having more than 500 responses to emergencies. Two thirds of emergency physicians had already completed their residency. Twenty percent of all participants had suspected an acute adrenal crisis at least once. Nevertheless, 66.6% of these participants had not asked or searched for an emergency card. Emergency physicians were asked whether any preclinical therapy besides volume infusion is necessary. Only 52% considered an additional therapy with no difference between residents and specialists (P=0.52). Specialists for internal medicine suggested an additional therapy significantly more often than specialists for other professions (P=0.01). There was no correlation between the number of emergency calls and considering additional therapy. Furthermore 94% of participants described insecurities about recognizing an acute adrenal crisis with only 67% asking for additional educational programs concerning acute adrenal crisis and its therapy. In summary, neither emergency physicians nor paramedics feel confident in recognizing patients with acute adrenal crisis. When suspecting an acute crisis two out of three did not ask or look for an emergency card (containing life-saving instructions). Half of the physicians did not consider any additional therapy besides volume infusion. Only specialization in internal medicine is associated with higher rates of specific additional therapy. We could show similar data for general practitioners in the past. We recommend additional education for the preclinical setting.
18 - 21 May 2019
European Society of Endocrinology