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

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.

Evaluation of blood product transfusion therapies in acute injury care in low- and middle-income countries: a systematic review

“…With the far-reaching impacts of injuries in LMICs [ 1-5 , 29 ] and the limited available research from these settings, additional study of blood product therapies, which are key to combating injury-related mortality, is crucial for informing clinical practice and policy. [42] 3, 5 Low Javali (2017) [43] 3 Moderate Kilyewala (2017) [57] 3, 4, 5 Very Low London (2001) [41] 2, 4 Low Mofidi (2010) [47] 2, 4, 5 Very Low Musau (2006) [50] 3, 4 Low Newton (2015) [51] 1, 3, 4, 5 Very Low Otieno (2004) [52] 3, 4 Low Sadeghi (2017) [48] 2, 3 Low Saidi (2014) [53] 3, 5 Low Sokhal (2017) [44] 3, 5 Low Srikant (2003) [45] 1, 3, 4 Very Low Tavousi (2018) [49] 3, 5 Low Yanar (2008) [56] 3 There is substantial research, including well-performed RCTs from HICs, that has led to development of consensus guidelines on the use of blood products in the treatment of acute injuries [ 14-16 , 18 , 59 , 60 ] [ 8 , 18 , 61 , 62 ]. Even though the global burden of injuries lies predominantly in LMICs [ 1-5 , 29 ], this systematic review demonstrates that there is a paucity of high-quality research from these settings.…”

“…Included reports were derived from Ghana (1) [41] , India (4) [42][43][44][45] , Iran (4) [46][47][48][49] , Kenya (4) [50][51][52][53] , South Africa (2) [ 54 , 55 ], Turkey (1) [56] and Uganda (1) [57] . The cumulative number of patients studied in all reports was 6535.…”

“…2 . The majority of patients studied were from the African Region (52.5%) [ 41 , 50-53 , 57 ], with smaller percentages from the South-East Asia Region [42][43][44][45] , European Region [56] and Eastern Mediterranean Region [46][47][48][49] . There was limited representation of nations within each WHO region, as only one country was represented in the European Region, one in the Eastern Mediterranean Region, one in the South-East Asia Region, and four in the African Region.…”

“…The quality of reports and assessment of bias based on the GRADE criteria are shown in Table 4 [32][33][34] . The overall quality of the sixteen included observational reports was either low (56.3%) or very low (37.5%), with one report [43] assessed to be of moderate quality (6.3%). The quality of evidence for the one included RCT was very low.…”

Failure Risk Factor For Non-Operative Treatment of Splenic Trauma

“…Alcohol consumption is common during trauma and might result in a falsely high value of lactate or prolong lactate clearance; it must, therefore, be taken into account when evaluating patients with a high blood alcohol level (21). The value of lactate and bicarbonates was identi ed as an important independent predictor of the polytrauma patient with acute alcohol and drug use (22,23).…”