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


ABSTRACT: The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for hemorrhage. We prospectively measured blood lactate levels and assessed retrospectively in 435 trauma patients both at the scene and on arrival at the emergency room (ER) of a level I trauma center. Primary outcome was immediate intervention for hemorrhage defined as surgical/radiological intervention and/or blood transfusion within 24?h. Physiological variables plus Lac scene significantly increased the predictive value for immediate intervention (area under the curve [AUC] 0.882, 95% confidence interval [CI] 0.839-0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787-0.887, P?=?0.0073), replicated in the validation cohort (n?=?85). There was no significant improvement in predicting value of physiological variables plus Lac scene for massive transfusion compared to physiological variables (AUC 0.903 vs 0.895, P?=?0.32). The increased blood lactate level per minute from scene to ER was associated with increased probability for immediate intervention (P?

SUBMITTER: Fukuma H 

PROVIDER: S-EPMC6760524 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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

Fukuma Hiroshi H   Nakada Taka-Aki TA   Shimada Tadanaga T   Shimazui Takashi T   Aizimu Tuerxun T   Nakao Shota S   Watanabe Hiroaki H   Mizushima Yasuaki Y   Matsuoka Tetsuya T  

Scientific reports 20190924 1


The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for hemorrhage. We prospectively measured blood lactate levels and assessed retrospectively in 435 trauma patients both at the scene and on arrival at the emergency room (ER) of a level I trauma center. Primary outcome was immediate intervention for hemorrhage defined as  ...[more]

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