Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study

Caputo, Nicholas D.; Fraser, Robert; Paliga, Andrew; Kanter, Marc; Hosford, Karlene; Madlinger, Robert

doi:10.1136/emermed-2012-201343

Cited by 41 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The clinical approach to trauma patients involves early identification of significant hemorrhaging and addressing (6)(7)(8). Other studies go one step further to show that biomarkers are more useful than vital signs in critically ill patients (9,10).…”

Section: Discussionmentioning

confidence: 98%

Determining the Utility of Metabolic Acidosis for Trauma Patients in the Emergency Department

Summersgill

Kanter

Fraser

et al. 2015

The Journal of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 98%

Determining the Utility of Metabolic Acidosis for Trauma Patients in the Emergency Department

Summersgill

Kanter

Fraser

et al. 2015

The Journal of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

“…Lactate is a product of anaerobic metabolism and can be used as a marker of hypoxia in different states of shock. Elevated serum levels on admission of multiple trauma patients is related to higher mortality 3 5 7 15 , higher mortality in patients affected by septic shock 6 and predict blood products need and also may aid in the early detection of severity 3 . Several researchers have established the use of lactate as a diagnostic and prognostic marker of severity and mortality 1 7 9 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have linked lactate >4 mmol/l as a major criterion of severity and chance of survival, rarely found in stable patients even with comorbidities 6 8 10 . Others show that patients with high blood lactate have higher risk of death compared to those with levels within the normal laboratory range 3 4 . The clearance of lactate may represent good parameter to analyze the quality of resuscitation measures in trauma 10 13 and information on prognosis, especially in early mortality.…”

Section: Introductionmentioning

confidence: 99%

Lactate as Predictor of Mortality in Polytrauma

Freitas

Franzon

2015

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Background: The lactate is a product of anaerobic metabolism; it can be used as a marker on demand and availability of oxygen. Changes in lactate levels can be effectively used as a marker in resuscitation maneuvers, even in patients with stable vital signs. Aim: To verify the lactate clearance as a predictor of mortality in trauma patients, in need of intensive care. Method: A total of 851 patients were admitted in ICU, in which 146 were victims of multiple trauma; due to the exclusion criteria, were included 117. Results: Patients were 87% male, mean age 32.4 years, motorcycle drivers, Glasgow coma scale between 3-8, affected by cranial trauma, followed by abdominal trauma. Was verified mortality up to 48 h and global mortality, that did not show statistical relationship between lactate clearance and mortality (p=0.928). Conclusion: There is no correlation between admission lactate or lactate clearance and mortality in patients treated with multiple trauma.

show abstract

“…BD is a metabolic marker and re ects the acid-base status of the patient. Due to the rapid availability of blood gases, BD is commonly used to assess haemorrhage and its consequences [12] [13] [14]. Several studies have documented its ability to predict outcome in trauma and highlighted its role in patient classi cation [11] [15] [16] [17] [18] [19].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the previous and current trauma-related shock classifications – The more the better? – A retrospective cohort study from a level I trauma centre

Jávor

Csonka

Butt

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The aim was to compare the predictive performance of the current, extended (VS+BD) Advanced Trauma Life Support (ATLS) classification for hypovolaemic shock over the previous, vital sign (VS)-based classification with respect to mortality outcomes. We also studied the prognostic values of heart rate (HR), systolic blood pressure (SBP), Glasgow Coma Scale (GCS) and base deficit (BD).Methods: The present study is a retrospective analysis at a level I trauma centre between 11 July 2014 and 11 September 2019. Trauma patients (inclusion criteria: trauma team activation, transport directly from scene, no need for resuscitation on scene, precise and detailed medical documentation, age ≥16, 30-day follow-up, complete dataset for HR, SBP, GCS and BD) were allocated to shock classes (I–IV) based on the VS and VS+BD criteria. The predictive values for the classifications were compared with a two-proportion Z-test, while individual parameters were examined with receiver operating characteristic (ROC) analyses.Results: A total of 156 patients met the inclusion criteria out of 60,037 trauma admissions. Both the VS and VS+BD classifications have shown a strong relation to mortality (P=0.0001 vs. P=0.000009). There was no significant difference in their predictive performance. According to the statistical analysis, GCS, BD and SBP showed significant prognostic values (AUCGCS=0.799 [CI: 0.722, 0.875]; AUCBD=0.683, [CI: 0.576, 0.790]; AUCSBP=0.633, [CI: 0.521, 0.744]). HR was found ineffective in predicting mortality. Conclusions: The current ATLS classification for hypovolaemic shock did not appear to be superior to the previous, VS-based classification in our study setting. GCS, BD and SBP were proven to be useful parameters in prognosticating outcome. The role of HR should be reconsidered, since it does not seem to reflect the clinical condition accurately.

show abstract

Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study

Abstract: Triage vital signs have no correlation to lactate or BD levels in penetrating trauma patients. Odds of operative intervention are greater in patients with abnormally high serum lactate levels, but not in those with abnormal triage vital signs or BD.

Cited by 41 publications

References 21 publications

Determining the Utility of Metabolic Acidosis for Trauma Patients in the Emergency Department

Determining the Utility of Metabolic Acidosis for Trauma Patients in the Emergency Department

Lactate as Predictor of Mortality in Polytrauma

Comparison of the previous and current trauma-related shock classifications – The more the better? – A retrospective cohort study from a level I trauma centre

Contact Info

Product

Resources

About