title: Diagnostic accuracy of a single point-of-care prehospital serum lactate for predicting outcomes in pediatric trauma patients.
abstract: BACKGROUND
  Preliminary evidence suggests that a single prehospital lactate level (pLA) improves prediction of morbidity and mortality in adult trauma patients independent of vital signs. However, the value of pLA for pediatric trauma patients is unknown. Our objective was to determine whether pLA is associated with the need for critical care in pediatric trauma patients.
  
  
  METHODS
  We conducted a cohort study of 217 patients transported by helicopter to a level I pediatric trauma center over 24 months. The primary outcome was the need for predefined critical care measures. Covariates included vital signs and Glasgow Coma Scale (GCS) scores documented by prehospital providers.
  
  
  RESULTS
  Forty-one subjects required critical care. Abnormal prehospital vital signs were not associated with need for critical care. Overall, median pLA level for patients who required critical care was 2.1 mmol/L (interquartile range [IQR], 1.6-2.7 mmol/L) versus 1.7 mmol/L (IQR, 1.2-2.2 mmol/L) for those who did not (P = 0.01). In addition, there were 85 subjects who had normal vital signs and a normal GCS during transport. Of these, 11 (13%) required critical care. In the subset of patients with normal prehospital vital signs and GCS, median pLA level for patients who required critical care was 2.6 mmol/L (IQR, 1.8-2.6 mmol/L) versus 1.7 mmol/L (IQR, 1-2.1 mmol/L) for those who did not (P = 0.01).
  
  
  CONCLUSIONS
  Prehospital lactate level was higher in pediatric trauma patients who required critical care, including those who had normal prehospital vital signs and GCS. In this cohort, lactate was an early identifier of children with severe traumatic injuries.
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Ami
authors.initials: A
authors.lastname: Shah
authors.forename: Francis
authors.initials: F
authors.lastname: Guyette
authors.forename: Brian
authors.initials: B
authors.lastname: Suffoletto
authors.forename: Brian
authors.initials: B
authors.lastname: Schultz
authors.forename: Jorge
authors.initials: J
authors.lastname: Quintero
authors.forename: Erin
authors.initials: E
authors.lastname: Predis
authors.forename: Christopher
authors.initials: C
authors.lastname: King
mesh_terms: D000293:Adolescent; D017732:Air Ambulances / Q000191:economics; D002648:Child; D003422:Critical Care; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007773:Lactates / Q000097:blood*; D008297:Male; D019095:Point-of-Care Systems; D011379:Prognosis; D018570:Risk Assessment; D014187:Transportation of Patients / Q000191:economics / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014218:Triage; D019564:Unnecessary Procedures; D055986:Vital Signs; D014947:Wounds and Injuries / Q000097:blood* / Q000175:diagnosis
chemical_list: D007773:Lactates