Abstract
BackgroundElevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients.MethodsWe conducted a prospective observational study in one level-I trauma centre. From August 2011 to February 2013, 120 consecutive adult patients with systolic blood pressure (SBP) higher than 90 mmHg were included. Capillary lactate was measured on admission in the trauma bay. The primary outcome was defined as a significant transfusion within the first 48 h. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. We also tested the agreement between capillary lactate and blood lactate concentrations using Bland and Altman analysis.ResultsOf the 120 normotensive trauma patients, 30 (25 %) required at least one unit of packed red blood cells (RBC) and 12 (10 %) patients received at least four RBC within the first 48 h. All patients with significant RBC transfusion had capillary lactate higher than 3.5 mmol/l. The area under the ROC curve of capillary lactate on admission to predict transfusion of at least 4 RBC units was 0.68 [95 % CI 0.58 – 0.78]. The average bias between capillary and blood lactate measurements was 2.4 mmol/l with a standard deviation of 3.0 mmol/l (n = 60 patients).ConclusionsAlthough a significant association was found between POC lactate concentration and transfusion requirements, the diagnostic performance of capillary lactate measurements was poor. Due to large disagreement between capillary lactate and blood lactate, capillary lactate cannot be considered in the clinical setting.Trial registrationClinicalTrials.gov, No. NCT01793428.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0272-x) contains supplementary material, which is available to authorized users.
Highlights
Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients
The yield of lactate concentration in a selected population of trauma patients with systolic arterial blood pressure (SBP) between 90 and 110 mmHg allowed for early identification of patients requiring significant transfusion [10]
The additional benefit of arterial lactate concentration to detect patients at risk for transfusion may be superior in patients with normal vital signs compared to patients with shock on admission
Summary
Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Measuring arterial lactate requires an automatic blood gas test and arterial blood sampling, which could be seen as invasive and expensive in patients with normal vital signs To overcome these limitations, handheld point-of-care (POC) fingertip lactate measurement was implemented in emergency departments with adequate accuracy to determine moderate increase in lactate levels [13]. Handheld point-of-care (POC) fingertip lactate measurement was implemented in emergency departments with adequate accuracy to determine moderate increase in lactate levels [13] Using this device in the pre-hospital setting, capillary lactate concentration higher than 3.5 mmol/l was associated with inhospital mortality in a study of 124 severe trauma patients requiring urgent ambulance dispatching [14]
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