title: Utility of admission serum lactate in pediatric trauma.
abstract: OBJECTIVE
  Serum lactate measurement has a predictive value in adult trauma. To date, there has been no prospective analysis of the predictive value of admission serum lactate in pediatric trauma.
  
  
  METHODS
  Admission serum lactate was prospectively measured over a two year period on all children under age 15 years who met trauma alert criteria at an urban Level 1 trauma center. Elevated serum lactate (>2.0 mmol/L) was correlated with Injury Severity Scores (ISS), injury types, and hospital outcomes.
  
  
  RESULTS
  A total of 277 injured children with admission lactate measurements were evaluated. Patients with elevated lactate had higher mean ISS than those with normal lactate (12.8 vs. 5.1, p<0.01), and increased need for intubation, major procedures and ICU admission. Elevated lactate was associated with low specificity (54.4%), moderate sensitivity (86.7%) and high negative predictive value (94.5%) for detecting injury (ISS>15). Lactate measurements over 4.7 mmol/L were highly specific (95.8%) for injury.
  
  
  CONCLUSIONS
  Elevated admission venous lactate level is associated with injury and outcomes, but lacks adequate sensitivity and specificity. Lactate over 4.7 mmol/L is strongly suggestive of severe injury, while lactate below 2.0 mmol/L is reassuring for not having injury. Lactates between 2.0 and 4.7 mmol/L remain indeterminate in predictive potential for injury or outcomes.
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 23298, United States. Electronic address: rramanat@mcvh-vcu.edu.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ramanathan
authors.affiliation: Department of Surgery, Virginia Commonwealth University Medical Center, Richmond, VA 3298, United States. Electronic address: dparrish@mcvh-vcu.edu.
authors.forename: Dan W
authors.initials: DW
authors.lastname: Parrish
authors.affiliation: Department of Surgery, Brown University, Providence, RI 02903, United States. Electronic address: joseph_hartwich@brown.edu.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Hartwich
authors.affiliation: Children's Hospital of Richmond, Virginia Commonwealth University Health System, 1200 East Broad Street, P.O. Box 980015, Richmond, VA 23298, United States. Electronic address: jhaynes@mcvh-vcu.edu.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Haynes
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000097:blood / Q000175:diagnosis* / Q000628:therapy
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
keywords: ISS; Lactate; Lactic acidosis; Pediatric trauma; Trauma