title: Association between a geriatric trauma resuscitation protocol using venous lactate measurements and early trauma surgeon involvement and mortality risk.
abstract: OBJECTIVE
  To investigate whether implementing a geriatric resuscitation protocol that uses lactate-guided therapy with early trauma surgeon involvement is associated with lower mortality through the early recognition of occult hypoperfusion (OH).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  All hemodynamically stable individuals with blunt trauma aged 65 and older admitted to the Level I trauma center from October 1, 2008, through December 31, 2011 (n = 1,998).
  
  
  METHODS
  Mortality over time (according to quarter) was analyzed using an adjusted logarithmic regression model stratified according to the presence of OH. OH was defined as lactate of 2.5 mM or greater.
  
  
  RESULTS
  Overall mortality was 3.9% (n = 78). Admission venous lactate was collected in 73.5% of participants, of whom 20.5% had OH (n = 301). In participants with OH, a significant decrease in mortality was observed over time (adjusted coefficient of determination (R(2) ) = 0.66, P = .002). A smaller yet significant decrease in mortality rates in participants with normal perfusion status was also observed (adjusted R(2) = 0.55, P = .01).
  
  
  CONCLUSIONS
  Early identification and treatment of OH in elderly adults with trauma using venous lactate-guided therapy coupled with early trauma surgeon involvement was associated with significantly lower mortality. A protocol that uses lactate-guided therapy with early trauma surgeon involvement should be followed to improve the care of elderly adults with trauma.
authors.affiliation: Trauma Research Department, St. Anthony Hospital, Lakewood, Colorado 80228, USA. dbaror@ampiopharma.com
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Salottolo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Orlando
authors.forename: Charles W
authors.initials: CW
authors.lastname: Mains
authors.forename: Pamela
authors.initials: P
authors.lastname: Bourg
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Offner
mesh_terms: D000369:Aged, 80 and over; D003120:Colorado; D003299:Cooperative Behavior; D061345:Early Medical Intervention / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D019983:Guideline Adherence; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000401:mortality; D033183:Interdisciplinary Communication; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D010348:Patient Care Team; D011446:Prospective Studies; D012044:Regression Analysis; D012151:Resuscitation / Q000379:methods*; D012306:Risk; D015996:Survival Rate; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014218:Triage; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000401:mortality* / Q000601:surgery*
chemical_list: D019344:Lactic Acid
keywords: geriatric; lactate; mortality; occult hypoperfusion; trauma