title: ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality.
abstract: OBJECTIVE
  Early recognition and treatment of sepsis improves outcomes. We determined the effects of bedside point-of-care (POC) lactate measurement on test turnaround time, time to administration of IV fluids and antibiotics, mortality, and ICU admissions in adult ED patients with suspected sepsis. We hypothesized that bedside lactate POC testing would reduce time to IV fluids and antibiotics.
  
  
  METHODS
  We compared 80 ED patients with suspected sepsis and a lactate level of 2 mmol/L or greater before and 80 similar patients after introduction of POC lactate measurements. Groups were compared with Χ(2) and Mann Whitney U tests. A sample size of 80 patients in each group had 85% power to detect a 30-minute difference in time to IV fluids or antibiotics.
  
  
  RESULTS
  Study groups were similar in age, gender, baseline lactate levels, sepsis severity, and Sequential Organ Failure Assessment (SOFA) scores. Introduction of POC lactate was associated with significant reductions in test turnaround time (34 [26-55] vs. 122 [82-149] minutes; P < 0.001), time to IV fluids (55 [34-83] vs. 71 [42-110] minutes; P = 0.03), mortality (6% vs. 19%; P = 0.02), and ICU admissions (33% vs. 51%, P = 0.02), but not time to IV antibiotics (89 [54-156] vs. 88 [60-177] minutes; P = 0.35).
  
  
  CONCLUSIONS
  Implementation of bedside POC lactate measurement in adult ED patients with suspected sepsis reduces time to test results and time to administration of IV fluids but not antibiotics. A significant reduction in mortality and ICU admissions was also demonstrated, which is likely due, at least in part, to POC testing.
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY. Electronic address: adam.singer@stonybrook.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Maria
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Debra
authors.initials: D
authors.lastname: LeBlanc
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Justin
authors.initials: J
authors.lastname: Williams
authors.affiliation: Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Thode
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D013997:Time Factors
chemical_list: D019344:Lactic Acid