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Javali RH, Ravindra P, Patil A, et al. A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients. Indian J Crit Care Med. 2017;21(11):719-725doi: 10.4103/ijccm.IJCCM_218_17.
Javali, R. H., Ravindra, P., Patil, A., Srinivasarangan, M., Mundada, H., Adarsh, S. B., & Nisarg, S. (2017). A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients. Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 21(11), 719-725. https://doi.org/10.4103/ijccm.IJCCM_218_17
Javali, Rameshbabu Homanna, et al. "A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients." Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 21,11 (2017): 719-725. doi: https://doi.org/10.4103/ijccm.IJCCM_218_17
Javali RH, Ravindra P, Patil A, Srinivasarangan M, Mundada H, Adarsh SB, Nisarg S. A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients. Indian J Crit Care Med. 2017 Nov;21(11):719-725. doi: 10.4103/ijccm.IJCCM_218_17. PMID: 29279631; PMCID: PMC5698998.
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Indian J Crit Care Med. 2017 Nov;21(11):719-725. doi: 10.4103/ijccm.IJCCM_218_17.

A Clinical Study on the Initial Assessment of Arterial Lactate and Base Deficit as Predictors of Outcome in Trauma Patients.

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

Rameshbabu Homanna Javali, Prithvishree Ravindra, Akkamahadevi Patil, Madhu Srinivasarangan, Harshit Mundada, S B Adarsh, S Nisarg

Affiliations

  1. Department of Emergency Medicine, JSS Medical College and Hospital, Mysore, Karnataka, India.
  2. Department of Emergency Medicine, Kasturba Medical College, Manipal, Karnataka, India.
  3. Department of Emergency Medicine, St. John's Medical College and Hospital, Bengaluru, Karnataka, India.

PMID: 29279631 PMCID: PMC5698998 DOI: 10.4103/ijccm.IJCCM_218_17

Abstract

BACKGROUND: Trauma is a leading cause of mortality in India. Outcomes can be improved by early recognition of hemorrhagic shock and expedited management. At present, we rely on traditional vital signs, which are not sensitive measures. Point of care biochemical markers have been emerging as prognostic markers in trauma, but have not been studied in Indian setting.

AIMS: This study aims to study the association between arterial lactate and base deficit (BD) at emergency department (ED) admission and 24 h outcome in trauma patients at risk of hemodynamic compromise.

MATERIALS AND METHODS: This was a prospective observational study on 100 trauma patients at risk of hemodynamic compromise in tertiary care center ED. Arterial blood gas analysis at admission and 24 h outcomes were noted and statistically analyzed.

RESULTS: Arterial lactate ≥4 mmol/L (sensitivity 100% and specificity 85.9%), BD ≥12 mEq/L (sensitivity 87.5% and specificity 82.6%) had more sensitivity than vital signs for predicting 24 h mortality. Higher lactate and BD were associated with increased blood transfusion requirement. Best cutoff values for predicting transfusion were lactate ≥2.9 mmol/L (sensitivity 65.2% and specificity 90.7%), BD ≥8 mEq/L (sensitivity 78.3% and specificity 75.9%). BD-based classification was comparable to ATLS classification in predicting mortality and determining transfusion requirements. Patients with higher arterial lactate and BD were found to have higher 24 h Intensive Care Unit (ICU) admission.

CONCLUSION: Emergency admission arterial lactate and Base Deficit are useful predictors of mortality, need for blood transfusion and ICU admission at 24 h. It can be used to triage, identify shock early, assess transfusion requirement, and prognosticate trauma patients.

Keywords: Base deficit; blood transfusion; lactate; mortality; trauma

Conflict of interest statement

There are no conflicts of interest.

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