Comparative study of traditional vital signs with blood lactate levels as a prognostic indicator for trauma patient in the ED

Dr. Ankit Biyani; Dr. Mayank Dhir; Dr. Sagar Sinha; Dr. Dattatray Bhusare

Volume : VIII, Issue : I, January - 2019

Comparative study of traditional vital signs with blood lactate levels as a prognostic indicator for trauma patient in the ED

Dr. Ankit Biyani, Dr. Mayank Dhir, Dr. Sagar Sinha, Dr. Dattatray Bhusare

Abstract :

Background: Traumatic injuries are a major causer of life threatening hemorrhage. Early recognition and assessment of the degree of hypoperfusion remains a challenge. Traditional vital signs are often used to help determine a trauma patient‘s hemodynamic status. Current hospital trauma triage systems are based mainly on physiological parameters, but in compensated shock injury severity may not be immediately obvious, as the physiological parameters remain normal for some time. Recent studies have demonstrated lactate as a biomarker capable of identifying high risk trauma patient. Objective: The purpose of this study was to determine if blood lactate levels in patients with normal systolic blood pressure have better predictive value for identifying patients with an elevated risk of significant transfusion and mortality. Methodology: A prospective observational study was undertaken at a tertiary teaching hospital in Navi Mumbai from January 2018 to May 2018. Baseline vital signs and lactate were recorded in all patients for whom the trauma team was activated. Informed consent was taken from subjects/attendants. Results: 40 patients were selected for the study. Analysis showed that 50% of the patients having high lactate levels needed aggressive care i.e. transfusion and/or surgery. Study also revealed that since p–value for the chi–square and Fisher’s exact test is less than that of 0.05 indicates significance of association between Lactate Level and Transfusion and surgery needed. Conclusion: These findings suggest that blood lactate measurements could improve trauma triage when used with early triage vitals like SBP and HR in predicting the need for aggressive care (requiring significant transfusion). A significant association was also found between blood lactate concentration and mortality in trauma patients. Blood lactate testing demonstrates that it is now capable of providing clarity in the often challenging ED environment. Further studies using blood lactate measurement are warranted.