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

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• 作者：Kristin M Salottolo (1) (2)
  Charles W Mains (1) (3) (4)
  Patrick J Offner (1) (3) (4)
  Pamela W Bourg (3)
  David Bar-Or (1) (2) (4)
  
• 关键词：Geriatric ; Occult hypoperfusion ; Shock index ; Circulatory hemodynamic instability
• 刊名：Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：21
• 期：1
• 全文大小：311KB
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• 作者单位：Kristin M Salottolo (1) (2)
  Charles W Mains (1) (3) (4)
  Patrick J Offner (1) (3) (4)
  Pamela W Bourg (3)
  David Bar-Or (1) (2) (4)
  
  1. Trauma Research Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA
  2. Trauma Research Department, Swedish Medical Center, Englewood, CO, 80113, USA
  3. Trauma Services Department, St. Anthony Hospital, Lakewood, CO, 80228, USA
  4. Rocky Vista University, Aurora, CO, 80011, USA
  

文摘

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.