A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground

Francis X. Guyette, Eric N. Meier, Craig Newgard, Barbara McKnight, Mohamud Ramzan Daya, Eileen M. Bulger, Judy L. Powell, Karen Brasel, Jeffery D. Kerby, Debra Egan, Michael Sise, Raul Coimbra, Timothy C. Fabian, David B. Hoyt

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)600-606
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume78
Issue number3
DOIs
StatePublished - Mar 6 2015

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Lactic Acid
Blood Pressure
Wounds and Injuries
Point-of-Care Systems
Confidence Intervals
Emergency Medical Services
Shock
Interventional Radiology
Triage
Trauma Centers
Thoracotomy
Resuscitation
Blood Transfusion
Laparotomy
Area Under Curve
Observational Studies
Hospital Emergency Service
Biomarkers
Heart Rate

Keywords

  • Lactate
  • prehospital
  • trauma

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground. / Guyette, Francis X.; Meier, Eric N.; Newgard, Craig; McKnight, Barbara; Daya, Mohamud Ramzan; Bulger, Eileen M.; Powell, Judy L.; Brasel, Karen; Kerby, Jeffery D.; Egan, Debra; Sise, Michael; Coimbra, Raul; Fabian, Timothy C.; Hoyt, David B.

In: Journal of Trauma and Acute Care Surgery, Vol. 78, No. 3, 06.03.2015, p. 600-606.

Research output: Contribution to journalArticle

Guyette, Francis X. ; Meier, Eric N. ; Newgard, Craig ; McKnight, Barbara ; Daya, Mohamud Ramzan ; Bulger, Eileen M. ; Powell, Judy L. ; Brasel, Karen ; Kerby, Jeffery D. ; Egan, Debra ; Sise, Michael ; Coimbra, Raul ; Fabian, Timothy C. ; Hoyt, David B. / A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 78, No. 3. pp. 600-606.
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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.",
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T1 - A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground

AU - Guyette, Francis X.

AU - Meier, Eric N.

AU - Newgard, Craig

AU - McKnight, Barbara

AU - Daya, Mohamud Ramzan

AU - Bulger, Eileen M.

AU - Powell, Judy L.

AU - Brasel, Karen

AU - Kerby, Jeffery D.

AU - Egan, Debra

AU - Sise, Michael

AU - Coimbra, Raul

AU - Fabian, Timothy C.

AU - Hoyt, David B.

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N2 - 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.

AB - 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.

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