The utility of venous lactate to triage injured patients in the trauma center

Robert F. Lavery, David H. Livingston, Bartholomew J. Tortella, Justin T. Sambol, Brian Slomovitz, John H. Siegel

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background: Field triage criteria for trauma patients results in over- triage rates of 30% to 50% to achieve under-triage rates of 10%. This large number of patients may stress trauma center resources. Elevated arterial lactate (ALAC) levels have been shown to be a marker of serious injury but the need for arterial sampling limits the utility of the determination. The goal of this study was: 1) to determine the correlation between venous lactate (VLAC) and ALAC; 2) to determine whether VLAC could identify those patients with serious injuries; and 3) to compare an elevated VLAC level against standard triage criteria (STC) in their ability to identify major injury. Study Design: Arterial and venous samples for blood gas and lactate analyses were obtained in 375 patients within 10 minutes of patient arrival to the trauma center. Arterial and venous samples were drawn within 2 minutes of each other, placed on ice, and analyzed within 10 minutes of sampling. The location of sampling was left to physician discretion. Data collected included injury mechanism, demographics, admission vital signs, emergency department disposition, length of stay, and injury severity scores (ISS). Admission to the ICU, need for emergency operation, length of stay, and death were noted. Emergency medical service staff were queried to determine which standard triage criteria (STC) were fulfilled. Results: The mean ALAC was 3.11 mmol/L (SD 3.45, 95% confidence interval [CI] 2.67 to 3.55) and mean VLAC was 3.43 mmol/L (SD 3.41, 95% CI 2.96 to 3.90). There was no significant difference between ALAC and VLAC. The correlation between ALAC and VLAC was 0.94 (95% CI 0.94 to 0.96, p = 0.0001). An elevated VLAC predicted moderate to severe injury and there was a significant association between an increased lactate and maximum Abbreviated Injury Score (AIS) of 4 and 5 (ANOVA, F = 8.26, p < 0.001). Patients with VLAC ≥ 2 mmol/L had significantly increased relative risks of ISS ≥ 13, death, admission to the ICU, and length of stay > 2 days. In comparison with STC, a VLAC ≥ 2 mmol/L decreased undertriage in patients with ISS ≥ 13 by one half (11% versus 24%) for patients with ISS ≥ 13 and decreased over-triage by 28% (46% versus 64%). These data were most pronounced for patients injured in motor vehicle collisions. Conclusions: VLAC is an excellent approximation for ALAC. A VLAC ≥ 2 mmol/L appears to predict an ISS ≥ 13, the need for ICU resources, and prolonged hospital stays. VLAC was significantly better than STC in all patients and was most useful in victims of blunt trauma, especially motor vehicle collisions. (C) 2000 American College of Surgeons.

Original languageEnglish (US)
Pages (from-to)656-664
Number of pages9
JournalJournal of the American College of Surgeons
Volume190
Issue number6
DOIs
StatePublished - Jun 2000
Externally publishedYes

Fingerprint

Triage
Trauma Centers
Lactic Acid
Injury Severity Score
Wounds and Injuries
Length of Stay
Motor Vehicles
Confidence Intervals
Blood Gas Analysis
Vital Signs
Medical Staff
Ice

ASJC Scopus subject areas

  • Surgery

Cite this

The utility of venous lactate to triage injured patients in the trauma center. / Lavery, Robert F.; Livingston, David H.; Tortella, Bartholomew J.; Sambol, Justin T.; Slomovitz, Brian; Siegel, John H.

In: Journal of the American College of Surgeons, Vol. 190, No. 6, 06.2000, p. 656-664.

Research output: Contribution to journalArticle

Lavery, Robert F. ; Livingston, David H. ; Tortella, Bartholomew J. ; Sambol, Justin T. ; Slomovitz, Brian ; Siegel, John H. / The utility of venous lactate to triage injured patients in the trauma center. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 6. pp. 656-664.
@article{025e4e00240245ea979406187a6d3443,
title = "The utility of venous lactate to triage injured patients in the trauma center",
abstract = "Background: Field triage criteria for trauma patients results in over- triage rates of 30{\%} to 50{\%} to achieve under-triage rates of 10{\%}. This large number of patients may stress trauma center resources. Elevated arterial lactate (ALAC) levels have been shown to be a marker of serious injury but the need for arterial sampling limits the utility of the determination. The goal of this study was: 1) to determine the correlation between venous lactate (VLAC) and ALAC; 2) to determine whether VLAC could identify those patients with serious injuries; and 3) to compare an elevated VLAC level against standard triage criteria (STC) in their ability to identify major injury. Study Design: Arterial and venous samples for blood gas and lactate analyses were obtained in 375 patients within 10 minutes of patient arrival to the trauma center. Arterial and venous samples were drawn within 2 minutes of each other, placed on ice, and analyzed within 10 minutes of sampling. The location of sampling was left to physician discretion. Data collected included injury mechanism, demographics, admission vital signs, emergency department disposition, length of stay, and injury severity scores (ISS). Admission to the ICU, need for emergency operation, length of stay, and death were noted. Emergency medical service staff were queried to determine which standard triage criteria (STC) were fulfilled. Results: The mean ALAC was 3.11 mmol/L (SD 3.45, 95{\%} confidence interval [CI] 2.67 to 3.55) and mean VLAC was 3.43 mmol/L (SD 3.41, 95{\%} CI 2.96 to 3.90). There was no significant difference between ALAC and VLAC. The correlation between ALAC and VLAC was 0.94 (95{\%} CI 0.94 to 0.96, p = 0.0001). An elevated VLAC predicted moderate to severe injury and there was a significant association between an increased lactate and maximum Abbreviated Injury Score (AIS) of 4 and 5 (ANOVA, F = 8.26, p < 0.001). Patients with VLAC ≥ 2 mmol/L had significantly increased relative risks of ISS ≥ 13, death, admission to the ICU, and length of stay > 2 days. In comparison with STC, a VLAC ≥ 2 mmol/L decreased undertriage in patients with ISS ≥ 13 by one half (11{\%} versus 24{\%}) for patients with ISS ≥ 13 and decreased over-triage by 28{\%} (46{\%} versus 64{\%}). These data were most pronounced for patients injured in motor vehicle collisions. Conclusions: VLAC is an excellent approximation for ALAC. A VLAC ≥ 2 mmol/L appears to predict an ISS ≥ 13, the need for ICU resources, and prolonged hospital stays. VLAC was significantly better than STC in all patients and was most useful in victims of blunt trauma, especially motor vehicle collisions. (C) 2000 American College of Surgeons.",
author = "Lavery, {Robert F.} and Livingston, {David H.} and Tortella, {Bartholomew J.} and Sambol, {Justin T.} and Brian Slomovitz and Siegel, {John H.}",
year = "2000",
month = "6",
doi = "10.1016/S1072-7515(00)00271-4",
language = "English (US)",
volume = "190",
pages = "656--664",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The utility of venous lactate to triage injured patients in the trauma center

AU - Lavery, Robert F.

AU - Livingston, David H.

AU - Tortella, Bartholomew J.

AU - Sambol, Justin T.

AU - Slomovitz, Brian

AU - Siegel, John H.

PY - 2000/6

Y1 - 2000/6

N2 - Background: Field triage criteria for trauma patients results in over- triage rates of 30% to 50% to achieve under-triage rates of 10%. This large number of patients may stress trauma center resources. Elevated arterial lactate (ALAC) levels have been shown to be a marker of serious injury but the need for arterial sampling limits the utility of the determination. The goal of this study was: 1) to determine the correlation between venous lactate (VLAC) and ALAC; 2) to determine whether VLAC could identify those patients with serious injuries; and 3) to compare an elevated VLAC level against standard triage criteria (STC) in their ability to identify major injury. Study Design: Arterial and venous samples for blood gas and lactate analyses were obtained in 375 patients within 10 minutes of patient arrival to the trauma center. Arterial and venous samples were drawn within 2 minutes of each other, placed on ice, and analyzed within 10 minutes of sampling. The location of sampling was left to physician discretion. Data collected included injury mechanism, demographics, admission vital signs, emergency department disposition, length of stay, and injury severity scores (ISS). Admission to the ICU, need for emergency operation, length of stay, and death were noted. Emergency medical service staff were queried to determine which standard triage criteria (STC) were fulfilled. Results: The mean ALAC was 3.11 mmol/L (SD 3.45, 95% confidence interval [CI] 2.67 to 3.55) and mean VLAC was 3.43 mmol/L (SD 3.41, 95% CI 2.96 to 3.90). There was no significant difference between ALAC and VLAC. The correlation between ALAC and VLAC was 0.94 (95% CI 0.94 to 0.96, p = 0.0001). An elevated VLAC predicted moderate to severe injury and there was a significant association between an increased lactate and maximum Abbreviated Injury Score (AIS) of 4 and 5 (ANOVA, F = 8.26, p < 0.001). Patients with VLAC ≥ 2 mmol/L had significantly increased relative risks of ISS ≥ 13, death, admission to the ICU, and length of stay > 2 days. In comparison with STC, a VLAC ≥ 2 mmol/L decreased undertriage in patients with ISS ≥ 13 by one half (11% versus 24%) for patients with ISS ≥ 13 and decreased over-triage by 28% (46% versus 64%). These data were most pronounced for patients injured in motor vehicle collisions. Conclusions: VLAC is an excellent approximation for ALAC. A VLAC ≥ 2 mmol/L appears to predict an ISS ≥ 13, the need for ICU resources, and prolonged hospital stays. VLAC was significantly better than STC in all patients and was most useful in victims of blunt trauma, especially motor vehicle collisions. (C) 2000 American College of Surgeons.

AB - Background: Field triage criteria for trauma patients results in over- triage rates of 30% to 50% to achieve under-triage rates of 10%. This large number of patients may stress trauma center resources. Elevated arterial lactate (ALAC) levels have been shown to be a marker of serious injury but the need for arterial sampling limits the utility of the determination. The goal of this study was: 1) to determine the correlation between venous lactate (VLAC) and ALAC; 2) to determine whether VLAC could identify those patients with serious injuries; and 3) to compare an elevated VLAC level against standard triage criteria (STC) in their ability to identify major injury. Study Design: Arterial and venous samples for blood gas and lactate analyses were obtained in 375 patients within 10 minutes of patient arrival to the trauma center. Arterial and venous samples were drawn within 2 minutes of each other, placed on ice, and analyzed within 10 minutes of sampling. The location of sampling was left to physician discretion. Data collected included injury mechanism, demographics, admission vital signs, emergency department disposition, length of stay, and injury severity scores (ISS). Admission to the ICU, need for emergency operation, length of stay, and death were noted. Emergency medical service staff were queried to determine which standard triage criteria (STC) were fulfilled. Results: The mean ALAC was 3.11 mmol/L (SD 3.45, 95% confidence interval [CI] 2.67 to 3.55) and mean VLAC was 3.43 mmol/L (SD 3.41, 95% CI 2.96 to 3.90). There was no significant difference between ALAC and VLAC. The correlation between ALAC and VLAC was 0.94 (95% CI 0.94 to 0.96, p = 0.0001). An elevated VLAC predicted moderate to severe injury and there was a significant association between an increased lactate and maximum Abbreviated Injury Score (AIS) of 4 and 5 (ANOVA, F = 8.26, p < 0.001). Patients with VLAC ≥ 2 mmol/L had significantly increased relative risks of ISS ≥ 13, death, admission to the ICU, and length of stay > 2 days. In comparison with STC, a VLAC ≥ 2 mmol/L decreased undertriage in patients with ISS ≥ 13 by one half (11% versus 24%) for patients with ISS ≥ 13 and decreased over-triage by 28% (46% versus 64%). These data were most pronounced for patients injured in motor vehicle collisions. Conclusions: VLAC is an excellent approximation for ALAC. A VLAC ≥ 2 mmol/L appears to predict an ISS ≥ 13, the need for ICU resources, and prolonged hospital stays. VLAC was significantly better than STC in all patients and was most useful in victims of blunt trauma, especially motor vehicle collisions. (C) 2000 American College of Surgeons.

UR - http://www.scopus.com/inward/record.url?scp=0034045176&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034045176&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(00)00271-4

DO - 10.1016/S1072-7515(00)00271-4

M3 - Article

C2 - 10873000

AN - SCOPUS:0034045176

VL - 190

SP - 656

EP - 664

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 6

ER -