The predictive value of serum lactate to forecast injury severity in trauma-patients increases taking age into account.

Autor: Hagebusch P; Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany. Paul.Hagebusch@BGU-Frankfurt.de., Faul P; Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany., Ruckes C; Interdisciplinary Center Clinical Trials (IZKS), University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany., Störmann P; Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany., Marzi I; Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany., Hoffmann R; Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany., Schweigkofler U; Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany., Gramlich Y; Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2024 Jun; Vol. 50 (3), pp. 635-642. Date of Electronic Publication: 2022 Jul 19.
DOI: 10.1007/s00068-022-02046-2
Abstrakt: Background: Two-tier trauma team activation (TTA)-protocols often fail to safely identify severely injured patients. A possible amendment to existing triage scores could be the measurement of serum lactate. The aim of this study was to determine the ability of the combination of serum lactate and age to predict severe injuries (ISS > 15).
Methods: We conducted a retrospective cohort study in a single level one trauma center in a 20 months study-period and analyzed every trauma team activation (TTA) due to the mechanism of injury (MOI). Primary endpoint was the correlation between serum lactate (and age) and ISS and mortality. The validity of lactate (LAC) and lactate contingent on age (LAC + AGE) were assessed using the area under the curve (AUC) of the receiver operating characteristics (ROC) curve. We used a logistic regression model to predict the probability of an ISS > 15.
Results: During the study period we included 325 patients, 75 met exclusion criteria. Mean age was 43 years (Min.: 11, Max.: 90, SD: 18.7) with a mean ISS of 8.4 (SD: 8.99). LAC showed a sensitivity of 0.82 with a specificity of 0.62 with an optimal cutoff at 1.72 mmol/l to predict an ISS > 15. The AUC of the ROC for LAC was 0.764 (95% CI: 0.67-0.85). The LAC + AGE model provided a significantly improved predictive value compared to LAC (0.765 vs. 0.828, p < 0.001).
Conclusions: The serum lactate concentration is able to predict injury severity. The prognostic value improves significantly taking the patients age into consideration. The combination of serum lactate and age could be a suitable Ad-on to existing two-tier triage protocols to minimize undertriage.
Level of Evidence: Level IV, retrospective cohort study.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
Externí odkaz: