title: [Nothing gained from the determinations of plasma lactate levels in the evaluation of a patient with acute abdomen].
abstract: OBJECTIVE
  To establish the diagnostic value of laboratory tests, especially the plasma lactate concentration, for determination of the indication for acute surgery in patients with an acute abdomen.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Kennemer Gasthuis, location Elisabeth Gasthuis, Haarlem, the Netherlands.
  
  
  METHODS
  The study group consisted of all 200 successive patients presenting at the emergency room with acute abdomen from June 1993 to December 1994 (19 months). Patients with suspected acute appendicitis were excluded. The diagnosis and indication for surgery if any were based on case history, physical examination, radiological examination if performed and standard laboratory tests: ESR, leukocyte count, haemoglobin, creatinine and amylase. The first matter considered was to what extent the indication for acute operation based on these clinical criteria was in agreement with the diagnosis at discharge. The next question studied was what would be the extra value of the plasma lactate concentration which, although determined, had not been reported to the clinician. Statistical analysis was performed using the two-sample Student t test and the chi 2 test. A p-value of < 0.05 was regarded as statistically significant.
  
  
  RESULTS
  Fifty-four patients were operated within 24 hours for good reasons, six were incorrectly not operated within 24 hours, 128 correctly received conservative treatment and 12 were correctly treated conservatively and subsequently underwent operation after longer than 24 hours. Diagnostics based on the clinical criteria had a sensitivity of 90%. The mean plasma lactate concentration, temperature and ESR were statistically significant more often increased in the operated patients than in those treated conservatively. The sensitivities of these determinations were 75%, 67% and 40% (all: p < 0.05). The lactate concentration was increased in 50% of the patients who in retrospect had incorrectly not been subjected to acute surgery.
  
  
  CONCLUSIONS
  Neither determination of the plasma lactate concentration nor the results of the separate standard laboratory tests in acute abdomen patients resulted in a better sensitivity for the determination of an indication for acute surgery than clinical examination combined with standard laboratory tests and, if desired, supplementary radiology.
authors.affiliation: Kennemer Gasthuis, afd. Chirurgie, Haarlem.
authors.forename: A C
authors.initials: AC
authors.lastname: Vahl
authors.forename: N J
authors.initials: NJ
authors.lastname: Out
authors.forename: B A
authors.initials: BA
authors.lastname: Kapteijn
authors.forename: A R
authors.initials: AR
authors.lastname: Koomen
mesh_terms: D000006:Abdomen, Acute / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005767:Gastrointestinal Diseases / Q000097:blood / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation; D012680:Sensitivity and Specificity
chemical_list: D019344:Lactic Acid
vernacular_title: Geen meerwaarde van bepaling lactaatplasmaconcentratie bij de beoordeling van een patiënt met een acute buik.