title: Capillary lactate as a tool for the triage nurse among patients with SIRS at emergency department presentation: a preliminary report.
abstract: BACKGROUND
  The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED.
  
  
  METHODS
  This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded.
  
  
  RESULTS
  One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87).
  
  
  CONCLUSIONS
  A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.
authors.affiliation: Medical Intensive Care Unit, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Cyril
authors.initials: C
authors.lastname: Manzon
authors.affiliation: Medical Intensive Care Unit, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Barrot
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Besch
authors.affiliation: Medical Intensive Care Unit, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Barbot
authors.affiliation: Emergency Department, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Desmettre
authors.affiliation: Medical Intensive Care Unit, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France ; Emergency Department, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France ; Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Rd, Melbourne, VIC 3004 Australia ; Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.affiliation: Medical Intensive Care Unit, Besançon University Hospital, Boulevard Fleming, 25030 Besançon, France ; Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Boulevard Fleming, 25030 Besançon, France.
authors.forename: Gaël
authors.initials: G
authors.lastname: Piton
keywords: Capillary lactate; Prognosis; Systemic inflammatory response syndrome; Triage tool