Pediatr Emerg Med J.  2021 Dec;8(2):81-86. 10.22470/pemj.2021.00360.

Point-of-care lactate: a predictor of emergency medicine resource use and outcomes in infants with diarrhea

• Lee J
• Moon HJ
• Kim DE
• Jeoung D
• Kim HJ
• Lee HJ
• Lee D

• KMID: 2523999
• DOI: http://doi.org/10.22470/pemj.2021.00360

Abstract

Purpose
Fluid therapy for diarrhea-induced dehydration inadvertently increases emergency department length of stay (EDLOS). To prevent this delay, we investigated the usefulness of triage using point-of-care (POC) lactate in infants with diarrhea.
Methods
This study was performed on infants with diarrhea who visited the emergency department from January 2019 through December 2020. According to the POC lactate concentration and the Korean Triage and Acuity Scale (KTAS) level, the infants were separately divided into the low (< 2 mmol/L), moderate (2-3.9), and high (≥ 4) lactate groups and the mild (KTAS 4-5) and severe (1-3) groups, respectively. Using these 2 group designations, we compared variables regarding the emergency medicine resource use and outcomes. To predict the prolonged EDLOS (≥ median value) we performed logistic regression and receiver operating characteristic analyses.
Results
A total of 540 infants were included. The median of EDLOS was 169 minutes (interquartile range, 103-220). Fluid therapy was more frequently performed in the high lactate group than in the low-moderate lactate groups (85.0% vs. 60.4%-73.6%; P = 0.025). The high lactate and severe groups respectively showed higher rates of hospitalization (40.0% vs. 3.8%-7.6% [P < 0.001] and 10.9% vs. 1.4% [P = 0.015]), and longer median EDLOS (259 minutes vs. 147-178 [P < 0.001] and 185 vs. 131 [P = 0.001]) compared to the low-moderate lactate and mild groups. Compared to the KTAS, lactate is more strongly associated with the prolonged EDLOS (lactate, adjusted odds ratio, 4.80 [95% confidence interval, 1.87-15.34] vs. KTAS, 3.52 [1.90-6.54]). The areas under curve for lactate and for the KTAS were 0.66 (0.60-0.73) and 0.62 (0.55-0.69), respectively (P = 0.058).
Conclusion
In infants with diarrhea, POC lactate can be a predictor of emergency medicine resource use and outcomes.

Keyword

Biomarkers; Diarrhea; Infant; Lactates; Triage

Figure

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  Fig. 1. Comparison of predicting performance for the prolonged EDLOS (≥ 169 minutes) between lactate (A) and the Korean Triage and Acuity Scale (B) using receiver operating characteristic curves. The areas under curve for lactate and for the Korean Triage and Acuity Scale were 0.66 (95% confidence interval, 0.60-0.73; cutoff value, 4 mmol/L) and 0.62 (0.55-0.69; level 3), respectively (P = 0.058).

Reference

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