Acute Crit Care.  2020 May;35(2):102-109. 10.4266/acc.2019.00780.

Inclusion of lactate level measured upon emergency room arrival in trauma outcome prediction models improves mortality prediction: a retrospective, single-center study

• Moon J
• Hwang K
• Yoon D
• Jung K

• KMID: 2502340
• DOI: http://doi.org/10.4266/acc.2019.00780

Abstract

Background
This study aimed to develop a model for predicting trauma outcomes by adding arterial lactate levels measured upon emergency room (ER) arrival to existing trauma injury severity scoring systems.
Methods
We examined blunt trauma cases that were admitted to our hospital during 2010– 2014. Eligibility criteria were cases with an Injury Severity Score of ≥9, complete Trauma and Injury Severity Score (TRISS) variable data, and lactate levels that were assessed upon ER arrival. Survivor and non-survivor groups were compared and lactate-based prediction models were generated using logistic regression. We compared the predictive performances of traditional prediction models (Revised Trauma Score [RTS] and TRISS) and lactate-based models using the area under the curve (AUC) of receiver operating characteristic curves.
Results
We included 829 patients, and the in-hospital mortality rate among these patients was 21.6%. The model that used lactate levels and age provided a significantly better AUC value than the RTS model. The model with lactate added to the TRISS variables provided the highest Youden J statistic, with 86.0% sensitivity and 70.8% specificity at a cutoff value of 0.15, as well as the highest predictive value, with a significantly higher AUC than the TRISS.
Conclusions
These findings indicate that lactate testing upon ER arrival may help supplement or replace traditional physiological parameters to predict mortality outcomes among Korean trauma patients. Adding lactate levels also appears to improve the predictive abilities of existing trauma outcome prediction models.

Keyword

lactate; mortality; prognosis; wounds and injuries

Figure

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  Figure 1. Study population. ER: emergency room; ISS: Injury Severity Score; TRISS: Trauma and Injury Severity Score.

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  Figure 2. Trauma outcomes in relation to initial lactate levels. Patients that died and those that survived had significantly different lactate levels (P<0.001).

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  Figure 3. (A) Comparison of the areas under the receiver operator characteristic curves for mortality between the Revised Trauma Score (RTS) and other models using lactate (LA). (B) Comparison of the areas under the receiver operator characteristic curves for mortality between the Trauma and Injury Severity Score (TRISS) and other models using TRISS predictor variables plus lactate. LAG: lactate plus age; ISS: Injury Severity Score; LAGISS: LAG plus ISS; LAGRTS: LAG plus RTS; LATRISS: LA plus TRISS.

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