Predictive Value of Point-of-care Lactate Measurement in Patients Meeting Level II and III Trauma Team Activation Criteria that Present to the Emergency Department: A Prospective Study

Abstract

Background: The aim of this study was to investigate the utility of early point-of-care (POC) lactate levels to help predict injury severity and ultimate emergency department (ED) disposition for trauma patients meeting Level II and III activation criteria. Methods: This was a blinded, prospective cohort study including a convenience sample of patients meeting our triage criteria for Level II or III team activation with stable vital signs. Bedside lactate samples were collected during the secondary survey. Clinical care/disposition was at the discretion of physicians who remained blinded to the bedside lactate result. An elevated lactate was defined as >2.0 mmol/L. Results: Ninety-six patients were in the study group; mean age was 41 ± 17 years, 26% were female, 57% were Hispanic, and 60% admitted. We found no difference in initial mean POC lactate levels (mmol/L) for admitted versus discharged groups and Injury Severity Score (ISS) ≥9 versus ISS <9 groups (3.71 [95% confidence interval (CI): 3.1–4.4] vs. 3.85 [95% CI: 2.8–4.9];P= 0.99 and 3.54 [95% CI: 2.7–4.4] vs. 3.89 [95% CI: 3.1–4.6];P= 0.60, respectively). Performance characteristics of early elevated lactate levels were poor both to predict need for hospital admission (sensitivity = 77% [65%–87%]; specificity = 26% [13%–43%]; negative predictive value [NPV] = 43% [27%–61%]; and positive predictive value [PPV] = 62% [56%–67%]) and to identify patients with ISS scores ≥9 (sensitivity = 76% [59%–89%]; specificity = 24% [14%–37%]; NPV = 65% [47%–80%]; and PPV = 36% [30%–41%]). Conclusions: For Level II/III, we found that early bedside lactate levels were not predictive of ISS ≥9 or the need for admission. Level of Evidence: III (diagnostic test).