| dc.description.abstract | Background: Trauma is the leading cause of death in the developed world. Accurate assessment of severity of
injuries is critical in informing treatment choices. Current models of assessing severity of injury are not without
limitations. The objective of this study therefore was to determine the diagnostic accuracy of serum lactate assays
in assessing injury severity and prediction of early outcomes among trauma patients.
Methods: This was a cross-sectional analytical study. Consecutive series of all eligible patients had a single venous
blood sample drawn for lactate assay analysis (index test) and a concurrent Kampala Trauma Score (KTS) II value
determination (reference test). Admitted patients were followed up to assess early outcomes (length of hospital stay
and mortality).
Results: Out of the 502 trauma patients recruited, 108 (22%) were severely injured, 394 (78%) had non-severe injuries,
and 183 were admitted. There was a significant difference between median (interquartile range (IQR)) lactate levels
among the severely injured (4.3 (2.6, 6.6)) and the non-severely injured (2.4 (1.6, 3.5), p < 0.001). After a 72-h follow-up of
the admitted patients, 102 (56%) were discharged, 61 (33%) remained in the hospital, 3 (2%) remained in the ICU, and
17 (3%) had died. The area under the receiver operator characteristic (ROC) curve was 0.75 for injury severity. Serum
lactate ≥2.0 mmol/l had a hazard ratio of 1.10 (p < 0.001) for emergency department disposition, 4.33 (p = 0.06) for the
72-h non-discharge disposition, and 1.19 (p < 0.001) for 72-h mortality. Serum lactate ≥2.0 mmol/l at admission
was useful in discriminating severe from non-severe injuries with a sensitivity of 88%, specificity of 38%, PPV of
30%, and NPV of 92%.
Conclusion: Hyperlactatemia in an emergency trauma patient suggests a high probability of severe injury.
Keywords: Serum lactate; Injury severity; Trauma; Outcome | en |
