Initial venous lactate levels in patients with isolated penetrating extremity trauma: a retrospective cohort study

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• 作者：I. W. Folkert (1)
  C. A. Sims (1)
  J. L. Pascual (1)
  S. R. Allen (1)
  P. K. Kim (1)
  C. W. Schwab (1)
  D. N. Holena (1) (2) (3)
  
  1. Department of Surgery ; Perelman School of Medicine ; University of Pennsylvania ; 3400 Spruce St ; 5 Maloney Bldg ; Philadelphia ; PA ; 19104 ; USA
  2. Center for Clinical Epidemiology and Biostatistics ; Perelman School of Medicine ; University of Pennsylvania ; Philadelphia ; PA ; USA
  3. The Leonard Davis Institute ; Wharton School of Business ; University of Pennsylvania ; Philadelphia ; PA ; USA
  
• 关键词：Trauma ; Penetrating ; Lactate ; Extremity
• 刊名：European Journal of Trauma and Emergency Surgery
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：41
• 期：2
• 页码：203-209
• 全文大小：292 KB
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• 刊物主题：Traumatic Surgery; Surgical Orthopedics; Emergency Medicine; Sports Medicine; Intensive / Critical Care Medicine; Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1863-9941

文摘

Introduction Elevated initial lactate levels have been shown to be associated with severe injury in trauma patients, but some patients who do not appear to be in shock also presented with elevated lactate levels. We hypothesized that in hemodynamically stable patients with isolated penetrating extremity trauma, initial lactate level does not predict clinically significant bleeding. Methods A 5-year institutional database review was performed. Hemodynamically stable patients (HR聽聽90) with isolated penetrating extremity trauma with an initial lactate sent were included. The exposure of interest was captured as a dichotomous variable by initial lactate level normal (N聽鈮ぢ?.2聽mEq/L), elevated (E聽>聽2.2聽mEq/L). The primary outcome measurement was clinically significant bleeding, defined by need for intervention (operation, angioembolization, or transfusion) or laboratory evidence of bleeding (presenting Hg聽2聽g/dL/24聽h). Chi-squared and Mann鈥揥hitney tests were used to compare variables. Results A total of 132 patients were identified. There were no differences in demographics or mechanism of injury between the N (n聽=聽43, 7聽%) and E (n聽=聽89, 14聽%) groups. Median lactate levels were 1.6 (IQR 1.2鈥?.9)聽mEq/dL vs. 3.8 (IQR 2.8鈥?.2) in the N and E groups, p聽p聽=聽0.82). Conclusions In hemodynamically stable patients with isolated penetrating trauma to the extremity, elevated initial venous lactate levels (>2.2聽mEq/L) are not associated with bleeding or need for interventions. Clinical judgment remains the gold standard for evaluation and management of these patients.