A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Guyette, Francis X.; Meier, Eric N.; Newgard, Craig; McKnight, Barbara; Daya, Mohamud; Bulger, Eileen M.; Powell, Judy L.; Brasel, Karen J.; Kerby, Jeffery D.; Egan, Debra; Sise, Michael; Coimbra, Raul; Fabian, Timothy C.; Hoyt, David B.
• Is Part Of: Journal of trauma and acute care surgery. Volume 78:Issue 3(2015:Mar.)
• Publication Date: 2015-03
• Subjects: Lactate -- prehospital -- trauma; Surgical intensive care -- Periodicals; Surgical emergencies -- Periodicals; Wounds and injuries -- Surgery -- Periodicals; 617.026
• DOI: 10.1097/TA.0000000000000549
• Languages: English
• ISSNs: 2163-0755

Abstract

Abstract : BACKGROUND: Reliance on prehospital trauma triage guidelines misses patients with serious injury. Lactate is a biomarker capable of identifying high-risk trauma patients. Our objective was to compare prehospital point-of-care lactate (P-LAC) with systolic blood pressure (SBP) for predicting the need for resuscitative care (RC) in trauma patients transported by ground emergency medical services. METHODS: This is a prospective observational study at nine sites within the Resuscitation Outcomes Consortium conducted from March 2011 to August 2012. Lactate was measured on patients with a prehospital SBP of 100 mm Hg or less who were transported by emergency medical services to a Level I or II trauma center. Patients were followed up for the need for RC, defined as any of the following within 6 hours of emergency department arrival: blood transfusion of 5 U or greater; intervention for hemorrhage including thoracotomy, laparotomy, pelvic fixation, or interventional radiology embolization; or death. RESULTS: A total of 387 patients had a lactate value and presented with SBP between 71 mm Hg and 100 mm Hg, and 70 (18%) required RC. With the use of a P-LAC decision rule (≥2.5 mmol/L) that yielded the same specificity as that of SBP of 90 mm Hg or less (48%), the observed sensitivities for RC were 93% (95% confidence interval [CI], 84–98%) for P-LAC of 2.5 mmol/L or greater and 67% (95% CI, 55–78%) for SBP of 90 mm Hg or less (McNemar's test, p < 0.001). P-LAC has an estimated area under the curve of 0.78 (95% CI, 0.73–0.83), which is statistically superior to that of SBP (0.59; 95% CI, 0.53–0.66) and shock index (heart rate / SBP) (0.66; 95% CI, 0.60–0.74). CONCLUSION: P-LAC obtained at the scene is associated with the need for RC. P-LAC is superior to other early surrogates for hypoperfusion (SBP and shock index) in predicting the need for RC in trauma patients with 70 mm Hg < SBP ⩽ 100 mm Hg. LEVEL OF EVIDENCE: Prognostic study, level II.