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Prevalence and clinical significance of point of care elevated lactate at emergency admission in older patients: a prospective study.
Gosselin, Mélanie; Mabire, Cédric; Pasquier, Mathieu; Carron, Pierre-Nicolas; Hugli, Olivier; Ageron, Françcois-Xavier; Dami, Fabrice.
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  • Gosselin M; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
  • Mabire C; Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Pasquier M; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
  • Carron PN; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
  • Hugli O; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
  • Ageron FX; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland.
  • Dami F; Emergency Department, Lausanne University Hospital, University of Lausanne, 1011, Lausanne, Switzerland. fabrice.dami@chuv.ch.
Intern Emerg Med ; 17(6): 1803-1812, 2022 09.
Article en En | MEDLINE | ID: mdl-35678940
OBJECTIVE: Patients who are over 65 years old represent up to 24% of emergency department (ED) admissions. They are at increased risk of under-triage due to impaired physiological responses. The primary objective of this study was to assess the prevalence of elevated lactate by point of care testing (POCT) in this population. The secondary objective was to assess the additional value of lactate level in predicting an early poor outcome, as compared to and combined with common clinical scores and triage scales. METHODS: This monocentric prospective study recruited ED patients who were over 65 years old between July 19th 2019 and June 17th 2020. Patients consulting for seizures or needing immediate assessment were excluded. POCT lactates were considered elevated if ≥ 2.5 mmol/L. A poor outcome was defined based on certain complications or therapeutic decisions. RESULTS: In total, 602 patients were included; 163 (27.1%) had elevated lactate and 44 (7.3%) had a poor outcome. There was no association between poor outcome and lactate level. Modified Early Warning Score (MEWS) was significantly associated with poor outcome, alongside National Early Warning Score (NEWS). Logistic regression also associated lactate level combined with MEWS and poor outcome. CONCLUSION: The prevalence of elevated lactate was 27.1%. Lactate level alone or combined with different triage scales or clinical scores such as MEWS, NEWS and qSOFA was not associated with prediction of a poor outcome. MEWS alone performed best in predicting poor outcome. The usefulness of POCT lactate measurement at triage is questionable in the population of 65 and above.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sepsis / Sistemas de Atención de Punto Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Intern Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA / MEDICINA INTERNA Año: 2022 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Italia
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Sepsis / Sistemas de Atención de Punto Tipo de estudio: Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Intern Emerg Med Asunto de la revista: MEDICINA DE EMERGENCIA / MEDICINA INTERNA Año: 2022 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Italia