Abstract P84: Pre-hospital Lactate Levels Are Better Predictors of Mortality and Hospital Admission Than Traditional Vital Signs
Intro: Traditional vital signs are routinely obtained in the pre-hospital environment. These vital signs are used to make triage and treatment decisions without showing strong relationships to illness severity. Conversely, elevated lactate levels are good predictors of outcome in the Emergency Department (ED) and inpatient areas. Recent advances in point of care (POC) testing have made the ability to accurately measure lactate readily available to EMS providers.
Hypothesis: We assessed the hypothesis that POC whole blood lactate, collected in the pre-hospital environment, will predict severity of illness measured by death and ED disposition.
Methods: Prospective, observational, blinded, cohort study involving 2 EMS systems; 1 urban and 1 rural. Data from 2,062 subjects transported to a Level 1 Trauma, Academic Medical Center, and 6 Community Hospitals were analyzed. Subjects evaluated were advanced life support transports. Traditional vital signs (blood pressure, heart rate, respiratory rate) and POC lactate (Lactate Pro) were measured during initial EMS assessment. Outcome variables [Death, ED disposition, type of admission (ICU or non-ICU)], were recorded for each ED visit. Receiving ED physicians were blinded to the pre-hospital lactate levels.
Results: Independent predictors of death and hospital admission were identified by using a logistic regression analysis. All hospitals were included in the analysis. Pre-hospital independent predictors of death included: POC lactate (OR 2.14; CI 1.19–3.85), HR (OR 1.04; CI 1.02–1.05), and age (OR 1.04; CI 1.02–1.07). Pre-hospital independent predictors of hospital admission were only POC lactate (OR 1.43; CI 1.17–1.75), and age (OR 1.03; CI 1.02–1.04).
Conclusions: POC lactate outperformed all pre-hospital vital signs in predicting ED disposition and mortality. Pre-hospital POC lactate allows providers to identify patients with a higher severity of illness not demonstrated by traditional vital signs Future knowledge of pre-hospital lactate values may enhance pre-hospital triage, transport and treatment decisions.