Abstract
The objective of this study was to assess whether the use of prehospital lactate (pLA) can increase the prognostic accuracy of the National Early Warning Score 2 (NEWS2) to detect the risk of death within 48 h. A prospective, multicenter study in adults treated consecutively by the emergency medical services (EMS) included six advanced life support (ALS) services and five hospitals. Patients were assigned to one of four groups according to their risk of mortality (low, low-medium, medium, and high), as determined by the NEWS2 score. For each group, the validity of pLA in our cohort was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. In this study, 3081 participants with a median age of 69 years (Interquartile range (IQR): 54–81) were included. The two-day mortality was 4.4% (137 cases). The scale derived from the implementation of the pLA improved the capacity of the NEWS2 to discriminate low risk of mortality, with an AUC of 0.910 (95% CI: 0.87–0.94; p < 0.001). The risk stratification provided by the NEWS2 can be improved by incorporating pLA measurement to more accurately predict the risk of mortality in patients with low risk.
Highlights
Assistance to people with acute disease in the prehospital context has evolved rapidly in recent years, making it possible to diagnose and treat bedside pathologies on many occasions [1]
The differences between survivors and nonsurvivors were significant in all the parameters that make up the National Early Warning Score 2 (NEWS2), such as it is the case of prehospital lactate (pLA) or the need for intensive care unit (ICU) (71 cases, 51.8%) (Table 2)
Multicenter study, we evaluated the ability of pLA to increase the prognostic accuracy of the NEWS2 for determining early mortality
Summary
Assistance to people with acute disease in the prehospital context has evolved rapidly in recent years, making it possible to diagnose and treat bedside pathologies on many occasions [1]. The National Early Warning Score 2 (NEWS2) [6] has proven to be useful in the prehospital context, is validated, and commonly used internationally [7,8,9]. One challenge faced by the EMS is the capability of detecting risk of mortality in patients with acute diseases [14], fundamentally in time-dependent pathologies where a diagnostic or therapeutic delay may negatively influence the outcome, thereby increasing morbidity and mortality [15]. These pathologies may not be suspected or detected initially. The use of any aid that can discriminate the risk of mortality should be evaluated because it can reduce the interval for definitive qualified health care [16]
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