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Overview :
Lavery et al
used venous lactate concentrations to triage trauma patients. This can help
reduce the tendency to over-triage patients to tertiary trauma centers. The
authors are from UMDNJ Medical School and the New Jersey Trauma
Center.
The advantage of
the venous lactate measurement is that it does not require an arterial sample.
estimated
arterial lactate concentration in mmol/L =
= (0.889 *
(venous lactate concentration in mmol/L)) + 0.076
A venous lactate
concentration >= 2.0 mmol/L:
(1) correlates
with an ISS >= 13
(2) the need for
ICU care
(3) increased
mortality
|
Venous
Lactate |
Mortality
Rate |
|
0 mmol/L |
4% |
|
2.5 mmol/L |
6% |
|
5.0 mmol/L |
12% |
|
7.5 mmol/L |
21% |
|
10.0
mmol/L |
38% |
|
12.5
mmol/L |
55% |
|
15.0
mmol/L |
71% |
|
17.5
mmol/L |
84% |
from Figure 4,
page 662
If this data is
analyzed in JMP:
percent
mortality =
= (-0.018909 *
((venous lactate)^3)) + (0.6839827 * ((venous lactate)^2)) - (1.62381 * (venous
lactate)) + 4.72727
Performance:
• Triage worked
best for patients with blunt trauma in motor vehicle
accidents.
Limitations:
• A small injury may not be associated
with a significant rise in lactate early, resulting in a false negative
result.
• The specimen needs to be collected,
transported and tested properly to give valid results.
| References: | |
Lavery RF, Livingston DH, et al. The
utility of venous lactate to triage injured patients in the trauma center. J Am
Coll Surg. 2000; 190: 656-664.
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