A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients

Rameshbabu Homanna Javali, Prithvishree Ravindra, Akkamahadevi Patil, Madhu Srinivasarangan, Harshit Mundada, S. B. Adarsh, S. Nisarg

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting. Aims: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise. Materials and Methods: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed. Results: Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission. Conclusion: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

Original languageEnglish
Pages (from-to)719-725
Number of pages7
JournalIndian Journal of Critical Care Medicine
Volume21
Issue number11
DOIs
Publication statusPublished - 01-11-2017
Externally publishedYes

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Lactic Acid
Wounds and Injuries
Sensitivity and Specificity
Mortality
Vital Signs
Blood Transfusion
Intensive Care Units
Hospital Emergency Service
Hemodynamics
Point-of-Care Systems
Blood Gas Analysis
Hemorrhagic Shock
Triage
Tertiary Care Centers
Observational Studies
Clinical Studies
India
Shock
Emergencies
Biomarkers

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Javali, Rameshbabu Homanna ; Ravindra, Prithvishree ; Patil, Akkamahadevi ; Srinivasarangan, Madhu ; Mundada, Harshit ; Adarsh, S. B. ; Nisarg, S. / A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients. In: Indian Journal of Critical Care Medicine. 2017 ; Vol. 21, No. 11. pp. 719-725.
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abstract = "Background: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting. Aims: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise. Materials and Methods: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed. Results: Arterial lactate ≥4 mmol/L (sensitivity 100{\%} and specificity 85.9{\%}), BD ≥12 mEq/L (sensitivity 87.5{\%} and specificity 82.6{\%}) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2{\%} and specificity 90.7{\%}), BD ≥8 mEq/L (sensitivity 78.3{\%} and specificity 75.9{\%}). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission. Conclusion: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.",
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A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients. / Javali, Rameshbabu Homanna; Ravindra, Prithvishree; Patil, Akkamahadevi; Srinivasarangan, Madhu; Mundada, Harshit; Adarsh, S. B.; Nisarg, S.

In: Indian Journal of Critical Care Medicine, Vol. 21, No. 11, 01.11.2017, p. 719-725.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A clinical study on the initial assessment of arterial lactate and base deficit as predictors of outcome in trauma patients

AU - Javali, Rameshbabu Homanna

AU - Ravindra, Prithvishree

AU - Patil, Akkamahadevi

AU - Srinivasarangan, Madhu

AU - Mundada, Harshit

AU - Adarsh, S. B.

AU - Nisarg, S.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Background: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting. Aims: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise. Materials and Methods: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed. Results: Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission. Conclusion: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

AB - Background: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting. Aims: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise. Materials and Methods: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed. Results: Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission. Conclusion: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

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JO - Indian Journal of Critical Care Medicine

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