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Utility of admission serum lactate in pediatric trauma
Rajesh Ramanathan1, Dan W Parrish2, Joseph E Hartwich3
1Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298, United States.
Insights
Admission serum lactate in pediatric trauma predicts injury severity. Elevated levels indicate significant injury, while levels below 2.0 mmol/L are reassuring. Values between 2.0-4.7 mmol/L are indeterminate.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Care
- Biomarkers in Critical Illness
Background:
- Serum lactate measurement is a known predictor of outcomes in adult trauma patients.
- Prospective analysis of admission serum lactate's predictive value in pediatric trauma is lacking.
Purpose of the Study:
- To prospectively evaluate the predictive value of admission serum lactate in children experiencing trauma.
- To correlate elevated serum lactate levels with injury severity and patient outcomes.
Main Methods:
- Prospective measurement of admission serum lactate in children (<15 years) meeting trauma alert criteria.
- Correlation of elevated lactate (>2.0 mmol/L) with Injury Severity Scores (ISS), injury types, and hospital outcomes.
- Analysis of sensitivity, specificity, and predictive values for detecting significant injury (ISS>15).
Main Results:
- 277 children were evaluated; elevated lactate correlated with higher mean ISS (12.8 vs. 5.1, p<0.01).
- Elevated lactate showed moderate sensitivity (86.7%) and high negative predictive value (94.5%) for ISS>15.
- Lactate >4.7 mmol/L was highly specific (95.8%) for severe injury.
Conclusions:
- Elevated admission lactate is associated with pediatric trauma severity and outcomes.
- Lactate >4.7 mmol/L strongly suggests severe injury; <2.0 mmol/L is reassuring.
- Lactate levels between 2.0-4.7 mmol/L have indeterminate predictive value for injury or outcomes.
Background/Purpose:
Serum lactate measurement has a predictive value in adult trauma. To date, there has been no prospective analysis of the predictive value of admission serum lactate in pediatric trauma.
Methods:
Admission serum lactate was prospectively measured over a two year period on all children under age 15 years who met trauma alert criteria at an urban Level 1 trauma center. Elevated serum lactate (>2.0 mmol/L) was correlated with Injury Severity Scores (ISS), injury types, and hospital outcomes.
Results:
A total of 277 injured children with admission lactate measurements were evaluated. Patients with elevated lactate had higher mean ISS than those with normal lactate (12.8 vs. 5.1, p<0.01), and increased need for intubation, major procedures and ICU admission. Elevated lactate was associated with low specificity (54.4%), moderate sensitivity (86.7%) and high negative predictive value (94.5%) for detecting injury (ISS>15). Lactate measurements over 4.7 mmol/L were highly specific (95.8%) for injury.
Conclusions:
Elevated admission venous lactate level is associated with injury and outcomes, but lacks adequate sensitivity and specificity. Lactate over 4.7 mmol/L is strongly suggestive of severe injury, while lactate below 2.0 mmol/L is reassuring for not having injury. Lactates between 2.0 and 4.7 mmol/L remain indeterminate in predictive potential for injury or outcomes.
