Prehospital lactate improves prediction of the need for immediate interventions for hemorrhage after trauma

Fukuma, Hiroshi; Nakada, Taka‐aki; Shimada, Tadanaga; Shimazui, Takashi; Aizimu, Tuerxun; Nakao, Shota; Watanabe, Hiroaki; Mizushima, Yasuaki; Matsuoka, Tetsuya

doi:10.1038/s41598-019-50253-6

“…Lactate concentration is widely used as an indicator of tissue hypoperfusion and hypoxia in critically ill patients and as a biomarker to determine response of the therapy or to predict outcome of the disease (Fukuma et al 2019;Shapiro et al 2005, Sharkey and Wellman, 2013, Vandromme et al 2010. As the end product lactate forms primarily during anaerobic glycolysis.…”

Section: Resultsmentioning

confidence: 99%

“…Vital signs are often used as an initial measure of hemodynamic stability in both humans and animals, but studies prove that they might grossly underestimate the depth of shock (Basel et al 2007;Scalea et al 1998). There are numerous studies, which investigate central venous oxygen saturation, base deficit and lactate changes being more accurate than vital signs (Basel et al 2007;Davis et al 1996;Fukuma et al 2019;Scalea et al 1998).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Blood Lactate Concentration in Dogs Receiving Whole Blood Transfusion

Zakarevičiūtė

¹

,

Juodžentė

²

,

Karvelienė

³

et al. 2020

IJAR

0

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Background: A blood transfusion is a routine, life-saving procedure used to replace blood cells or blood products. The current study was aimed to assess whether the blood lactate concentration has a prognostic value of successful blood transfusion.Methods: During the period 2018-2019 group I dogs (n=19) received whole blood transfusion and twenty dogs were assigned to the control group (group II). Blood samples in group I were obtained from cephalic vein before blood transfusion (T0), then after it was finished (4hr±20 min) (T1) and 24hr±20 min after the T0 (T2).Result: The level of blood lactate reached the normal level after blood transfusion in T1 and T2. The clearance of lactate had a moderate negative correlation with packed cell volume (PCV) and red blood cells (RBC). There was no significant correlation between survival rate and blood lactate level. The survivals 24hr after transfusion (T2) had five times higher count of reticulocytes (RETIC) then non-survivals. Serial blood lactate measurement can improve the prediction of successful blood transfusion and it is useful in monitoring the patient status 24hr post blood transfusion, but it doesn’t have the predictive value of survival.

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“…Nevertheless, we showed no in uence of transport on in-hospital mortality. Other studies did no report strong evidence of any bene ce of HEMS on in-hospital mortality among injured patients (31,32,33) Fukuma et al showed that physiological variables plus lactate on-scene signi cantly increased the predictive value for immediate intervention for hemorrhage (Area Under the Curve 0.882, 95% CI 0.839-0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787-0.887, p = 0.0073) (34). It may be interesting to investigate the role of on-scene lactate measuring during eld triage and its impact on undertriage.…”

Section: Discussionmentioning

confidence: 99%

“…Table 2 reports injuries characteristics and outcome of injured patients. ISS was higher in correct-triaged patient (25 [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] vs 21.5 [17][18][19][20][21][22][23][24][25][26][27][28][29], p < 0.0001)). The most frequent severely injured (AIS ≥ 3) body areas were head (53.57%) and thorax (54.11%).…”

Section: Overall Characteristicsmentioning

confidence: 99%

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Benhamed¹,

Fraticelli²,

Claustre³

et al. 2020

Preprint

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BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.

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“…Nevertheless, we showed no in uence of transport on in-hospital mortality. Other studies did no report strong evidence of any bene ce of HEMS on in-hospital mortality among injured patients (31,32,33) Fukuma et al showed that physiological variables plus lactate on-scene signi cantly increased the predictive value for immediate intervention for hemorrhage (Area Under the Curve 0.882, 95% CI 0.839-0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787-0.887, p = 0.0073) (34). It may be interesting to investigate the role of on-scene lactate measuring during eld triage and its impact on undertriage.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Benhamed

¹

,

FRATICELLI²,

CLAUSTRE³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

BackgroundThe proper prehospital triage and transportation of patients suffering major trauma to lever 1 trauma centers is associated with better outcomes. Hence, emergency medical systems (EMS) aim is to avoid undertriage in these patients. The main objective of this study was to assess the rate and predictors of undertriage in a physician-led prehospital system.MethodsWe conducted an observational multicentric, region-wide, retrospective study based on the RESUVal Trauma-System registry, Rhône-Alpes region, France. All adults assessed by physician-led EMS units, from January 2011 to December 2017 with major trauma (Injury Severity Score (ISS) ≥ 16) were included. We defined the correct-triage group as major trauma patients admitted to a level I trauma center. We performed univariate then multivariate logistic regressions with undertriage as outcome.ResultsA total of 7,110 patients were included in the registry, of whom 2,591 patients with an ISS≥ 16. Among these patients, 320 (12.35%) were undertriaged. Median ISS was 25. In-hospital mortality was 16.45% (n=351/2134). Mid-aged patients (51-65 years old) were associated with a higher risk of undertriage than the others (OR=1.62, 95%CI 1.15-2.28, p=0.01). Factors associated with a lower risk of undertriage were: mechanism (fall or gunshot/stabbing wounds, 0.62, [0.45-0.86], p=0.01 and 0.44, [0.22-0.9], p=0.02, respectively), time on-scene (over 60 minutes, 0.61, [0.38-0.95], p=0.03), prehospital need for endotracheal intubation and ultrasound examination (0.53, [0.39-0.72], p<0.001 and 0.15, [0.08-0.29], p<0.001 respectively). After adjusting for severity, undertriage showed a non-significant tendency toward an increased risk of mortality (1.22, [0.8-1.89], p=0.36).ConclusionsIn our region-wide, physician-led prehospital system, undertriage of major trauma was not rare. The typical profile of undertriaged patients was a mid-aged male suffering from a blunt trauma, without respiratory distress or neurologic impairment, not benefiting from prehospital ultrasound examination and located close to a non-trauma center hospital.

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Prehospital lactate improves prediction of the need for immediate interventions for hemorrhage after trauma

Cited by 21 publications

References 25 publications

Evaluation of Blood Lactate Concentration in Dogs Receiving Whole Blood Transfusion

Evaluation of Blood Lactate Concentration in Dogs Receiving Whole Blood Transfusion

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

Predictors of Undertriage after Major Trauma in a Physician-led Prehospital System: Insights of a French Registry

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