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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2013

Open Access 01-12-2013 | Original research

A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs

Authors: Kristin M Salottolo, Charles W Mains, Patrick J Offner, Pamela W Bourg, David Bar-Or

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2013

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Abstract

Background

Traditional vital signs (TVS), including systolic blood pressure (SBP), heart rate (HR) and their composite, the shock index, may be poor prognostic indicators in geriatric trauma patients. The purpose of this study is to determine whether lactate predicts mortality better than TVS.

Methods

We studied a large cohort of trauma patients age ≥ 65 years admitted to a level 1 trauma center from 2009-01-01 - 2011-12-31. We defined abnormal TVS as hypotension (SBP < 90 mm Hg) and/or tachycardia (HR > 120 beats/min), an elevated shock index as HR/SBP ≥ 1, an elevated venous lactate as ≥ 2.5 mM, and occult hypoperfusion as elevated lactate with normal TVS. The association between these variables and in-hospital mortality was compared using Chi-square tests and multivariate logistic regression.

Results

There were 1987 geriatric trauma patients included, with an overall mortality of 4.23% and an incidence of occult hypoperfusion of 20.03%. After adjustment for GCS, ISS, and advanced age, venous lactate significantly predicted mortality (OR: 2.62, p < 0.001), whereas abnormal TVS (OR: 1.71, p = 0.21) and SI ≥ 1 (OR: 1.18, p = 0.78) did not. Mortality was significantly greater in patients with occult hypoperfusion compared to patients with no sign of circulatory hemodynamic instability (10.67% versus 3.67%, p < 0.001), which continued after adjustment (OR: 2.12, p = 0.01).

Conclusions

Our findings demonstrate that occult hypoperfusion was exceedingly common in geriatric trauma patients, and was associated with a two-fold increased odds of mortality. Venous lactate should be measured for all geriatric trauma patients to improve the identification of hemodynamic instability and optimize resuscitative efforts.
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Literature
1.
Allgower M, Burri C: ["Shock index"]. Dtsch Med Wochenschr. 1967, 92: 1947-1950. 10.1055/s-0028-1106070.CrossRefPubMed
2.
Paladino L, Subramanian RA, Nabors S, Sinert R: The utility of shock index in differentiating major from minor injury. Eur J Emerg Med. 2011, 18: 94-98. 10.1097/MEJ.0b013e32833f212b.CrossRefPubMed
3.
Zarzaur BL, Croce MA, Magnotti LJ, Fabian TC: Identifying life-threatening shock in the older injured patient: an analysis of the National Trauma Data Bank. J Trauma. 2010, 68: 1134-1138. 10.1097/TA.0b013e3181d87488.CrossRefPubMed
4.
Scalea TM, Simon HM, Duncan AO, Atweh NA, Sclafani SJ, Phillips TF, Shaftan GW: Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma. 1990, 30: 129-134. discussion 134–126CrossRefPubMed
5.
Victorino GP, Chong TJ, Pal JD: Trauma in the elderly patient. Arch Surg. 2003, 138: 1093-1098. 10.1001/archsurg.138.10.1093.CrossRefPubMed
6.
Lehmann R, Beekley A, Casey L, Salim A, Martin M: The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis. Am J Surg. 2009, 197: 571-574. 10.1016/j.amjsurg.2008.12.037. discussion 574–575CrossRefPubMed
7.
Martin JT, Alkhoury F, O'Connor JA, Kyriakides TC, Bonadies JA: 'Normal' vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg. 2010, 76: 65-69.PubMed
8.
Rogers A, Rogers F, Bradburn E, Krasne M, Lee J, Wu D, Edavettal M, Horst M: Old and undertriaged: a lethal combination. Am Surg. 2012, 78: 711-715.PubMed
9.
Eastridge BJ, Salinas J, McManus JG, Blackburn L, Bugler EM, Cooke WH, Convertino VA, Wade CE, Holcomb JB: Hypotension begins at 110 mm Hg: redefining "hypotension" with data. J Trauma. 2007, 63: 291-297. 10.1097/TA.0b013e31809ed924. discussion 297–299CrossRefPubMed
10.
Jansen TC, van Bommel J, Mulder PG, Rommes JH, Schieveld SJ, Bakker J: The prognostic value of blood lactate levels relative to that of vital signs in the pre-hospital setting: a pilot study. Crit Care. 2008, 12: R160-10.1186/cc7159.PubMedCentralCrossRefPubMed
11.
Paladino L, Sinert R, Wallace D, Anderson T, Yadav K, Zehtabchi S: The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs. Resuscitation. 2008, 77: 363-368. 10.1016/j.resuscitation.2008.01.022.CrossRefPubMed
12.
Pudelek B: Geriatric trauma: special needs for a special population. AACN Clin Issues. 2002, 13: 61-72. 10.1097/00044067-200202000-00007.CrossRefPubMed
13.
Schulman AM, Claridge JA, Young JS: Young versus old: factors affecting mortality after blunt traumatic injury. Am Surg. 2002, 68: 942-947. discussion 947–948PubMed
14.
Vandromme MJ, Griffin RL, Weinberg JA, Rue LW, 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. 10.1016/j.jamcollsurg.2010.01.012. 867–869CrossRefPubMed
15.
Kruse O, Grunnet N, Barfod C: Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med. 2011, 19: 74-10.1186/1757-7241-19-74.PubMedCentralCrossRefPubMed
16.
Neville AL, Nemtsev D, Manasrah R, Bricker SD, Putnam BA: Mortality risk stratification in elderly trauma patients based on initial arterial lactate and base deficit levels. Am Surg. 2011, 77: 1337-1341.PubMed
17.
Antonelli M, Levy M, Andrews PJ, Chastre J, Hudson LD, Manthous C, Meduri GU, Moreno RP, Putensen C, Stewart T, Torres A: Hemodynamic monitoring in shock and implications for management. International Consensus Conference, Paris, France, 27–28 April 2006. Intensive Care Med. 2007, 33: 575-590. 10.1007/s00134-007-0531-4.CrossRefPubMed
18.
Bradburn E, Rogers FB, Krasne M, Rogers A, Horst MA, Belan MJ, Miller JA: High-risk geriatric protocol: Improving mortality in the elderly. J Trauma Acute Care Surg. 2012, 73: 435-440. 10.1097/TA.0b013e31825c7cf4.CrossRefPubMed
19.
Jacobs DG, Plaisier BR, Barie PS, Hammond JS, Holevar MR, Sinclair KE, Scalea TM, Wahl W: Practice management guidelines for geriatric trauma: the EAST Practice Management Guidelines Work Group. J Trauma. 2003, 54: 391-416. 10.1097/01.TA.0000042015.54022.BE.CrossRefPubMed
20.
Bourg P, Richey M, Salottolo K, Mains CW: Development of a geriatric resuscitation protocol, utilization compliance, and outcomes. J Trauma Nurs. 2012, 19: 50-56.CrossRefPubMed
21.
22.
23.
Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL: Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009, 66: 1040-1044. 10.1097/TA.0b013e3181895e9e.CrossRefPubMed
24.
Howell MD, Donnino M, Clardy P, Talmor D, Shapiro NI: Occult hypoperfusion and mortality in patients with suspected infection. Intensive Care Med. 2007, 33: 1892-1899. 10.1007/s00134-007-0680-5.CrossRefPubMed
25.
Shapiro NI, Howell MD, Talmor D, Nathanson LA, Lisbon A, Wolfe RE, Weiss JW: Serum lactate as a predictor of mortality in emergency department patients with infection. Ann Emerg Med. 2005, 45: 524-528. 10.1016/j.annemergmed.2004.12.006.CrossRefPubMed
26.
Phillips S, Rond PC, Kelly SM, Swartz PD: The failure of triage criteria to identify geriatric patients with trauma: results from the Florida Trauma Triage Study. J Trauma. 1996, 40: 278-283. 10.1097/00005373-199602000-00018.CrossRefPubMed
27.
Blow O, Magliore L, Claridge JA, Butler K, Young JS: The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999, 47: 964-969. 10.1097/00005373-199911000-00028.CrossRefPubMed
28.
Claridge JA, Crabtree TD, Pelletier SJ, Butler K, Sawyer RG, Young JS: Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma. 2000, 48: 8-14. 10.1097/00005373-200001000-00003. discussion 14–15CrossRefPubMed
29.
Thom O, Taylor DM, Wolfe RE, Myles P, Krum H, Wolfe R: Pilot study of the prevalence, outcomes and detection of occult hypoperfusion in trauma patients. Emerg Med J. 2010, 27: 470-472. 10.1136/emj.2009.073254.CrossRefPubMed
30.
Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH: The utility of venous lactate to triage injured patients in the trauma center. J Am Coll Surg. 2000, 190: 656-664. 10.1016/S1072-7515(00)00271-4.CrossRefPubMed
31.
Meregalli A, Oliveira RP, Friedman G: Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care. 2004, 8: R60-R65. 10.1186/cc2423.PubMedCentralCrossRefPubMed
Metadata
Title
A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs
Authors
Kristin M Salottolo
Charles W Mains
Patrick J Offner
Pamela W Bourg
David Bar-Or
Publication date
01-12-2013
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1757-7241-21-7

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