nach oben

European Journal of Trauma and Emergency Surgery

Erschienen in:

03.11.2021 | Original Article

Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism

verfasst von: Paul Hagebusch, Philipp Faul, Alexander Klug, Yves Gramlich, Reinhard Hoffmann, Uwe Schweigkofler

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 4/2022

Einloggen, um Zugang zu erhalten

Abstract

Background

The identification of risk factors for severe injury is crucial in trauma triage and trauma team activation (TTA) depends on a sufficient triage. The aim of this study was to determine whether or not elevated serum lactate levels and age are risk factors for severe injury in TTA due to trauma mechanism.

Methods

We conducted a retrospective cohort study in a single level one trauma center between September 2019 and May 2021 and analysed every TTA due to trauma mechanism. Primary endpoint of interest was the association of serum lactate as well as age with injury severity assessed by the injury severity score (ISS).

Results

During the study period, we included 250 patients. Mean age was 43.3 years (Min.: 11, Max.: 90, SD: 18.7) and the initial lactate level was 1.7 mmol/L (SD: 0.95) with a mean ISS of 8.4 (SD: 8.99). The adjusted odds ratio (OR) for age > 65 being associated with an ISS > 16 is 9.7 (p < 0.001; 95% CI 4.01–25.58) and for lactate > 2.2 mmol/L being associated with an ISS > 16 is 6.29 (p < 0.001; 95% CI 2.93–13.48). A lactate level of > 4 mmol/L results in a 36-fold higher risk of severe injury with an ISS > 16 (OR 36.06; 95% CI 4–324.29).

Conclusion

This study identifies age (> 65) and lactate (> 2.2 mmol/L) as independent risk factors for severe injury in a TTA due to trauma mechanism. Existing triage protocols might benefit from congruous amendments.

Van Rein EAJ, Houwert RM, Gunning AC, Lichtveld RA, Leenen LPH, Van Heijl M. Accuracy of prehospital triage protocols in selecting severely injured patients: a systematic review. J Trauma Acute Care Surg. 2017;83:328–39. https://doi.org/10.1097/TA.0000000000001516.CrossRefPubMed

Rotondo M, Cribari C, Smith R. Resources for optimal care of the traumatised patient. 6th ed. Chicago: American College of Surgeons; 2014.

Polites SF, Leonard JM, Glasgow AE, Zielinski MD, Jenkins DH, Habermann EB. Undertriage after severe injury among United States trauma centers and the impact on mortality. Am J Surg. 2018;216:813–8. https://doi.org/10.1016/j.amjsurg.2018.07.061.CrossRefPubMed

Holst JA, Perman SM, Capp R, Haukoos JS, Ginde AA. Undertriage of trauma-related deaths in U.S. emergency departments. West J Emerg Med. 2016;17:315–23. https://doi.org/10.5811/westjem.2016.2.29327.CrossRefPubMedPubMedCentral

Newgard CD, Staudenmayer K, Hsia RY, Mann NC, Bulger EM, Holmes JF, et al. The cost of overtriage: more than one-third of low-risk injured patients were taken to major trauma centers. Health Aff (Millwood). 2013;32:1591–9. https://doi.org/10.1377/hlthaff.2012.1142.CrossRef

Faul M, Wald MM, Sullivent EE, Sasser SM, Kapil V, Lerner EB, et al. Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers. Prehosp Emerg Care. 2012;16:222–9. https://doi.org/10.3109/10903127.2011.615013.CrossRefPubMed

Ochsner MG, Schmidt JA, Rozycki GS, Champion HR. The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe? J Trauma. 1995;39:971–7. https://doi.org/10.1097/00005373-199511000-00025.CrossRefPubMed

Rehn M, Lossius HM, Tjosevik KE, Vetrhus M, OstebaO O, Eken T. Efficacy of a two-tiered trauma team activation protocol in a Norwegian trauma centre. Br J Surg. 2012;99:199–208. https://doi.org/10.1002/bjs.7794.CrossRefPubMedPubMedCentral

Jenkins P, Rogers J, Kehoe A, Smith JE. An evaluation of the use of a two-tiered trauma team activation system in a UK major trauma centre. Emerg Med J. 2015;32:364–7. https://doi.org/10.1136/emermed-2013-203402.CrossRefPubMed

10.

Linder F, Holmberg L, Bjorck M, Juhlin C, Thorbjornsen K, Wisinger J, et al. A prospective stepped wedge cohort evaluation of the new national trauma team activation criteria in Sweden - The TRAUMALERT study. Scand J Trauma Resusc Emerg Med. 2019;27:1–10. https://doi.org/10.1186/s13049-019-0619-1.CrossRef

11.

Davis T, Dinh M, Roncal S, Byrne C, Petchell J, Leonard E, et al. Prospective evaluation of a two-tiered trauma activation protocol in an Australian major trauma referral hospital. Injury. 2010;41:470–4. https://doi.org/10.1016/j.injury.2010.01.003.CrossRefPubMed

12.

Voskens FJ, Van Rein EAJ, Van Der Sluijs R, Houwert RM, Lichtveld RA, Verleisdonk EJ, et al. Accuracy of prehospital triage in selecting severely injured trauma patients. JAMA Surg. 2018;153:322–7. https://doi.org/10.1001/jamasurg.2017.4472.CrossRefPubMed

13.

Jagan N, Morrow LE, Walters RW, Plambeck RW, Patel TM, Moore DR, et al. Sympathetic stimulation increases serum lactate concentrations in patients admitted with sepsis: implications for resuscitation strategies. Ann Intensive Care. 2021;11:24. https://doi.org/10.1186/s13613-021-00805-9.CrossRefPubMedPubMedCentral

14.

Kushimoto S, Akaishi S, Sato T, Nomura R, Fujita M, Kudo D, et al. Lactate, a useful marker for disease mortality and severity but an unreliable marker of tissue hypoxia/hypoperfusion in critically ill patients. Acute Med Surg. 2016;3:293–7. https://doi.org/10.1002/ams2.207.CrossRefPubMedPubMedCentral

15.

Baxter J, Cranfield KR, Clark G, Harris T, Bloom B, Gray AJ. Do lactate levels in the emergency department predict outcome in adult trauma patients? A systematic review. J Trauma Acute Care Surg. 2016;81:555–66. https://doi.org/10.1097/TA.0000000000001156.CrossRefPubMed

16.

Vandromme MJ, Griffin RL, Weinberg JA, Rue LW 3rd, Kerby JD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: could prehospital measures improve trauma triage? J Am Coll Surg. 2010;210:861–867,867–869. https://doi.org/10.1016/j.jamcollsurg.2010.01.012.

17.

Guyette FX, Meier EN, Newgard C, McKnight B, Daya M, Bulger EM, et al. A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground. J Trauma Acute Care Surg. 2015;78:600–6. https://doi.org/10.1097/TA.0000000000000549.CrossRefPubMed

18.

Oh TK, Song I-A, Bae H-J, Jeon Y-T. Serum lactate level upon admission to the neuro-intensive care unit and 90-day mortality: a retrospective study. J Clin Neurosci. 2019;70:173–7. https://doi.org/10.1016/j.jocn.2019.08.029.CrossRefPubMed

19.

Richards JE, Mazzeffi MA, Massey MS, Rock P, Galvagno SM, Scalea TM. The bitter and the sweet: relationship of lactate, glucose, and mortality after severe blunt trauma. Anesth Analg. 2020. https://doi.org/10.1213/ane.0000000000005335.CrossRefPubMed

20.

Raa A, Sunde GA, Bolann B, Kvåle R, Bjerkvig C, Eliassen HS, et al. Validation of a point-of-care capillary lactate measuring device (Lactate Pro 2). Scand J Trauma Resusc Emerg Med. 2020;28:83. https://doi.org/10.1186/s13049-020-00776-z.CrossRefPubMedPubMedCentral

21.

Wilson MS, Konda SR, Seymour RB, Karunakar MA. Early predictors of mortality in geriatric patients with trauma. J Orthop Trauma. 2016;30:e299-304. https://doi.org/10.1097/BOT.0000000000000615.CrossRefPubMed

22.

Hashmi A, Ibrahim-Zada I, Rhee P, Aziz H, Fain MJ, Friese RS, et al. Predictors of mortality in geriatric trauma patients: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2014;76:894–901. https://doi.org/10.1097/TA.0b013e3182ab0763.CrossRefPubMed

23.

Kodadek LM, Selvarajah S, Velopulos CG, Haut ER, Haider AH. Undertriage of older trauma patients: is this a national phenomenon? J Surg Res. 2015;199:220–9. https://doi.org/10.1016/j.jss.2015.05.017.CrossRefPubMed

24.

Uribe-Leitz T, Jarman MP, Sturgeon DJ, Harlow AF, Lipsitz SR, Cooper Z, et al. National study of triage and access to trauma centers for older adults. Ann Emerg Med. 2020;75:125–35. https://doi.org/10.1016/j.annemergmed.2019.06.018.CrossRefPubMed

25.

Bertil Bouillon, Pieper D. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF Regist. 2016.

26.

Bolorunduro OB, Villegas C, Oyetunji TA, Haut ER, Stevens KA, Chang DC, et al. Validating the injury severity score (ISS) in different populations: ISS predicts mortality better among hispanics and females. J Surg Res. 2011;166:40–4. https://doi.org/10.1016/j.jss.2010.04.012.CrossRefPubMed

27.

Abouleish AE, Leib ML, Cohen NH. ASA provides examples to each ASA physical status class. ASA Newsl. 2015;79:38–49.

28.

Hurwitz EE, Simon M, Vinta SR, Zehm CF, Shabot SM, Minhajuddin A, et al. Adding examples to the ASA-physical status classification improves correct assignment to patients. Anesthesiology. 2017;126:614–22. https://doi.org/10.1097/ALN.0000000000001541.CrossRefPubMed

29.

Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate Lars. Mayo Clin Proc. 2013;88:1127–40. https://doi.org/10.1016/j.mayocp.2013.06.012.CrossRefPubMed

30.

Brown JB, Lerner EB, Sperry JL, Billiar TR, Peitzman AB, Guyette FX. Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level. J Trauma Acute Care Surg. 2016;81:445–52. https://doi.org/10.1097/TA.0000000000001085.CrossRefPubMedPubMedCentral

31.

St John AE, McCoy AM, Moyes AG, Guyette FX, Bulger EM, Sayre MR. Prehospital lactate predicts need for resuscitative care in non-hypotensive trauma patients. West J Emerg Med. 2018;19:224–31. https://doi.org/10.5811/westjem.2017.10.34674.CrossRefPubMedPubMedCentral

32.

Demidenko E. Sample size and optimal design for logistic regression with binary interaction. Stat Med. 2008;27:36–46. https://doi.org/10.1002/sim.2980.CrossRefPubMed

33.

Schoeneberg C, Schilling M, Keitel J, Kauther MD, Burggraf M, Hussmann B, et al. TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 guideline on treatment of polytrauma/severe injuries—an approach for validation by a retrospective analysis of 2304 patients (2002–2011) of a Level 1 Trauma Centre TT—Traumanetzwerk, TraumaReg. Zentralbl Chir. 2017;142:199–208. https://doi.org/10.1055/s-0033-1360225.CrossRefPubMed

34.

Marzi I, Lustenberger T, Störmann P, Mörs K, Wagner N, Wutzler S. Steigender Vorhalteaufwand für den SchockraumIncreasing overhead ressources of the trauma room. Unfallchirurg. 2019;122:53–8. https://doi.org/10.1007/s00113-018-0484-9.CrossRefPubMed

35.

Hagebusch P, Faul P, Naujoks F, Klug A, Hoffmann R, Schweigkofler U. Trauma-team-activation in Germany: how do emergency service professionals use the activation due to trauma mechanism? Results from a nationwide survey. Eur J Trauma Emerg Surg. 2020. https://doi.org/10.1007/s00068-020-01425-x.CrossRefPubMed

36.

Fröhlich M, Caspers M, Lefering R, Driessen A, Bouillon B, Maegele M, et al. Do elderly trauma patients receive the required treatment? Epidemiology and outcome of geriatric trauma patients treated at different levels of trauma care. Eur J Trauma Emerg Surg. 2020;46:1463–9. https://doi.org/10.1007/s00068-019-01285-0.CrossRefPubMed

37.

Bardes JM, Benjamin E, Schellenberg M, Inaba K, Demetriades D. Old age with a traumatic mechanism of injury should be a trauma team activation criterion. J Emerg Med. 2019;57:151–5. https://doi.org/10.1016/j.jemermed.2019.04.003.CrossRefPubMed

38.

Demetriades D, Sava J, Alo K, Newton E, Velmahos GC, Murray JA, et al. Old age as a criterion for trauma team activation. J Trauma Inj Infect Crit Care. 2001;51:754–6. https://doi.org/10.1097/00005373-200110000-00022.CrossRef

39.

Caterino JM, Brown NV, Hamilton MW, Ichwan B, Khaliqdina S, Evans DC, et al. Effect of geriatric-specific trauma triage criteria on outcomes in injured older adults: a statewide retrospective cohort study. J Am Geriatr Soc. 2016;64:1944–51. https://doi.org/10.1111/jgs.14376.CrossRefPubMedPubMedCentral

40.

Fernandez FB, Ong A, Martin AP, Schwab CW, Wasser T, Butts CA, et al. Success of an expedited emergency department triage evaluation system for geriatric trauma patients not meeting trauma activation criteria. Emerg Med. 2019;11:241–7. https://doi.org/10.2147/OAEM.S212617.CrossRef

41.

Baron BJ, Nguyen A, Stefanov D, Shetty A, Zehtabchi S. Clinical value of triage lactate in risk stratifying trauma patients using interval likelihood ratios. Am J Emerg Med. 2018;36:784–8. https://doi.org/10.1016/j.ajem.2017.10.015.CrossRefPubMed

42.

Wentling J, Krall SP, McNierney A, Dewey K, Richman PB, Blow O. Predictive value of point-of-care lactate measurement in patients meeting level II and III trauma team activation criteria that present to the emergency department: a prospective study. J Emerg Trauma Shock. 2019;12:203–8. https://doi.org/10.4103/JETS.JETS_120_18.CrossRefPubMedPubMedCentral

43.

Martín-Rodríguez F, López-Izquierdo R, Castro Villamor MA, Mangas IM, Del Brío IP, Delgado Benito JF, et al. Prognostic value of lactate in prehospital care as a predictor of early mortality. Am J Emerg Med. 2019;37:1627–32. https://doi.org/10.1016/j.ajem.2018.11.028.CrossRefPubMed

44.

Davis JW, Dirks RC, Kaups KL, Tran P. Base deficit is superior to lactate in trauma. Am J Surg. 2018;215:682–5. https://doi.org/10.1016/j.amjsurg.2018.01.025.CrossRefPubMed

45.

Davis JW, Sue LP, Dirks RC, Kaups KL, Kwok AM, Wolfe MM, et al. Admission base deficit is superior to lactate in identifying shock and resuscitative needs in trauma patients. Am J Surg. 2020;220:1480–4. https://doi.org/10.1016/j.amjsurg.2020.10.005.CrossRefPubMed

46.

Gale SC, Kocik JF, Creath R, Crystal JS, Dombrovskiy VY. A comparison of initial lactate and initial base deficit as predictors of mortality after severe blunt trauma. J Surg Res. 2016;205:446–55. https://doi.org/10.1016/j.jss.2016.06.103.CrossRefPubMed

47.

Raux M, Le Manach Y, Gauss T, Baumgarten R, Hamada S, Harrois A, et al. Comparison of the prognostic significance of initial blood lactate and base deficit in trauma patients. Anesthesiology. 2017;126:522–33. https://doi.org/10.1097/ALN.0000000000001490.CrossRefPubMed

48.

Ter Avest E, Griggs J, Wijesuriya J, Russell MQ, Lyon RM. Determinants of prehospital lactate in trauma patients: a retrospective cohort study. BMC Emerg Med. 2020;20:18. https://doi.org/10.1186/s12873-020-00314-1.CrossRefPubMedPubMedCentral

49.

Cerović O, Golubović V, Špec-Marn A, Kremžar B, Vidmar G. Relationship between injury severity and lactate levels in severely injured patients. Intensive Care Med. 2003;29:1300–5. https://doi.org/10.1007/s00134-003-1753-8.CrossRefPubMed

50.

Vincent J, Quintairos E, Silva A, Couto L, Taccone F. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care. 2016;20:257. https://doi.org/10.1186/S13054-016-1403-5.CrossRefPubMedPubMedCentral

51.

Dekker SE, de Vries H-M, Lubbers WD, van de Ven PM, Toor EJ, Bloemers FW, et al. Lactate clearance metrics are not superior to initial lactate in predicting mortality in trauma. Eur J Trauma Emerg Surg. 2017;43:841–51. https://doi.org/10.1007/s00068-016-0733-y.CrossRefPubMed

52.

Klein K, Lefering R, Jungbluth P, Lendemans S, Hussmann B. Is prehospital time important for the treatment of severely injured patients? A matched-triplet analysis of 13,851 patients from the TraumaRegister DGU®. Biomed Res Int. 2019. https://doi.org/10.1155/2019/5936345.CrossRefPubMedPubMedCentral

53.

Martín-Rodríguez F, López-Izquierdo R, Delgado Benito JF, Sanz-García A, del Pozo VC, Castro Villamor MÁ, et al. Prehospital point-of-care lactate increases the prognostic accuracy of national early warning score 2 for early risk stratification of mortality: results of a multicenter, observational study. J Clin Med. 2020;9:1156. https://doi.org/10.3390/jcm9041156.CrossRefPubMedCentral

54.

Martín-Rodríguez F, López-Izquierdo R, Medina-Lozano E, Ortega Rabbione G, del Pozo Vegas C, Carbajosa Rodríguez V, et al. Accuracy of prehospital point-of-care lactate in early in-hospital mortality. Eur J Clin Invest. 2020;50:e13341. https://doi.org/10.1111/eci.13341.CrossRefPubMed

Titel: Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism
verfasst von: Paul Hagebusch
Philipp Faul
Alexander Klug
Yves Gramlich
Reinhard Hoffmann
Uwe Schweigkofler
Publikationsdatum: 03.11.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 4/2022
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01811-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Elevated serum lactate levels and age are associated with an increased risk for severe injury in trauma team activation due to trauma mechanism

Abstract

Background

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Background

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2022

Synthesis of the evidence on the impact of pre-operative direct oral anticoagulants on patient health outcomes after hip fracture surgery: rapid systematic review

Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis

Risk factors of hospitalization costs and length of stay for tibial plateau fractures

Orthogeriatric co-management: differences in outcome between major and minor fractures

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Prognostic value of orthogeriatric assessment parameters on mortality: a 2-year follow-up

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

Fehlerkultur in der Medizin – Offenheit zählt!

Mehr Frauen im OP – weniger postoperative Komplikationen

Update Orthopädie und Unfallchirurgie